OBJECTIVE: To evaluate tissue protection by PGE1 during leg ischemia in patients undergoing aortic surgery. DESIGN: Randomized, controlled prospective clinical trial. SETTING: Single university hospital. PARTICIPANTS: 19 consecutive patients undergoing abdominal aortic aneurysm repair. INTERVENTIONS: Patients received infusions of 30 ng/kg/min of PGE1 or saline. MEASUREMENTS AND MAIN RESULTS:Hemodynamic variables, lactate, creatine phosphokinase, and thromboxane B2 (TXB2) were measured. In the control group, the decrease in cardiac index (CI) after aortic cross-clamping (AXC) persisted until unclamping together with a decrease in femoral venous O2 content (CfvO2). In the PGE1 group, CI returned to baseline with a trend toward greater CfvO2 levels. During reperfusion in the PGE1 group, O2 consumption and lactate levels exceeded preclamp values. Pulmonary hypertension occurred equally in both groups but did not correlate with TXB2, which was not altered by surgery or by PGE1 infusion. CONCLUSIONS:Intraoperative PGE1 treatment offers no benefit and may exacerbate tissue ischemia during AXC by redistributing microcirculatory flow or limiting cellular oxygen utilization in a manner that overwhelms any possible protective effect.
RCT Entities:
OBJECTIVE: To evaluate tissue protection by PGE1 during leg ischemia in patients undergoing aortic surgery. DESIGN: Randomized, controlled prospective clinical trial. SETTING: Single university hospital. PARTICIPANTS: 19 consecutive patients undergoing abdominal aortic aneurysm repair. INTERVENTIONS:Patients received infusions of 30 ng/kg/min of PGE1 or saline. MEASUREMENTS AND MAIN RESULTS: Hemodynamic variables, lactate, creatine phosphokinase, and thromboxane B2 (TXB2) were measured. In the control group, the decrease in cardiac index (CI) after aortic cross-clamping (AXC) persisted until unclamping together with a decrease in femoral venous O2 content (CfvO2). In the PGE1 group, CI returned to baseline with a trend toward greater CfvO2 levels. During reperfusion in the PGE1 group, O2 consumption and lactate levels exceeded preclamp values. Pulmonary hypertension occurred equally in both groups but did not correlate with TXB2, which was not altered by surgery or by PGE1 infusion. CONCLUSIONS: Intraoperative PGE1 treatment offers no benefit and may exacerbate tissue ischemia during AXC by redistributing microcirculatory flow or limiting cellular oxygen utilization in a manner that overwhelms any possible protective effect.
Authors: Enrique María San Norberto García; James Henry Taylor; Noelia Cenizo; Carlos Vaquero Journal: Interact Cardiovasc Thorac Surg Date: 2014-01-14