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ARTICLE |

Triiodothyronine and Cardiac Surgery FREE

Bedford F. Boylston, MD
JAMA. 1996;276(2):100-100. doi:10.1001/jama.1996.03540020022013
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To the Editor.  —The article by Dr Bennett-Guerrero and colleagues1 gives the impression that triiodothyronine (T3) is being considered for routine use in the community as an inotropic agent after coronary artery bypass surgery. My hospital's cost for T3 is $900, and the cost for dopamine is $15. Dopamine will always be preferential on a routine basis on cost alone.Animal data show that T3 is most beneficial after severe global myocardial ischemia.2-4 Yet the study by Bennett-Guerrero et al excluded all preoperative patients requiring intraaortic balloon pump or inotropic support. Essentially, the group of patients most likely to benefit were excluded from the trial.The comparison of a hormone to an inotropic agent is the comparison of apples to oranges. The mechanism of action is different. No one is sure how T3 works on myocardial cell function. I agree that dopamine is the

REFERENCES

Bennett-Guerrero E, Jimenez JL, White WD, D'Amico EB, Baldwin BI, Schwinn DA, for the Duke T3 Study Group.  Cardiovascular effects of intravenous triiodothyronine in patients undergoing coronary artery bypass graft surgery: a randomized, double-blind, placebo-controlled trial . JAMA . 1996;;275:687-692.
Wechsler AS, Kadletz M, Ding M, Abd-Elfattah A, Dyke C.  Effects of triiodothyronine on stunned myocardium . J Cardiovasc Surg (Torino) . 1993;;8( (suppl 2) ):338-341.
Dyke GM, Yeh T Jr, Lehman JD, et al.  Triiodothyronine enhanced left ventricular function after ischemic injury . Ann Thorac Surg . 1991;;52:14-19.
Klemperer JD, Zelano J, Helm RE, et al.  Triiodothyronine improves left ventricular function without oxygen wasting effects after global hypothermic ischemia . J Thorac Cardiovasc Surg . 1995;;109:457-465.

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Bennett-Guerrero E, Jimenez JL, White WD, D'Amico EB, Baldwin BI, Schwinn DA, for the Duke T3 Study Group.  Cardiovascular effects of intravenous triiodothyronine in patients undergoing coronary artery bypass graft surgery: a randomized, double-blind, placebo-controlled trial . JAMA . 1996;;275:687-692.
Wechsler AS, Kadletz M, Ding M, Abd-Elfattah A, Dyke C.  Effects of triiodothyronine on stunned myocardium . J Cardiovasc Surg (Torino) . 1993;;8( (suppl 2) ):338-341.
Dyke GM, Yeh T Jr, Lehman JD, et al.  Triiodothyronine enhanced left ventricular function after ischemic injury . Ann Thorac Surg . 1991;;52:14-19.
Klemperer JD, Zelano J, Helm RE, et al.  Triiodothyronine improves left ventricular function without oxygen wasting effects after global hypothermic ischemia . J Thorac Cardiovasc Surg . 1995;;109:457-465.
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