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Better Bypass Outcomes

Slower rewarming reduces risk of cognitive decline after heart surgery

MONDAY, April 26, 2004 (HealthDayNews) -- An extra 10 to 15 minutes of rewarming time for patients after they have cardiac bypass surgery reduces the risk of cognitive decline, say Duke University Medical Center researchers who urge their colleagues to adopt the practice.

In a new study, the researchers use Duke as an example of a medical facility that changed longstanding procedure and instituted slower rewarming rates for cardiac bypass surgery patients.

The Duke experts note that rapid rewarming of these patients can result in their brain temperature going above the intended level and possibly spiking high enough to harm the brain. Slower rewarming reduces that risk.

Over a seven-year period at Duke, the maximum temperatures of patients being rewarmed following coronary artery bypass surgery dropped an average of more than 1.5 degrees Celsius, said the study, presented April 26 at the annual scientific sessions of the Society of Cardiovascular Anesthesiologists.

During cardiac bypass surgery, a patient's heart is stopped and his or her blood is cooled as it passes through a heart-lung machine to protect the patient's brain and other organs from damage. The blood needs to be rewarmed as the surgery comes to an end.

Many surgical teams remain unaware of the importance of how the rate of rewarming can affect patient outcome following cardiac bypass surgery, the Duke researchers said.

"The reasons why slower rewarming has not become more widespread are numerous, ranging from the inherent resistance to changing longstanding medical practices, to not wanting to spend the additional time in the operating room," Duke cardiothoracic anesthesiologist Dr. Hilary Grocott said in a prepared statement.

"However, these new data show that it is indeed possible to change practice, even at a very large institution like Duke. The small amount of extra time it takes to rewarm slowly is definitely worth the benefits to our patients," Grocott said.

More information

The American Heart Association has more about bypass surgery.

SOURCE: Duke University, news release, April 26, 2004
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