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The Journal of Thoracic and Cardiovascular Surgery, Vol 101, 269-274, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
SV Lichtenstein, KA Ashe, H el Dalati, RJ Cusimano, A Panos and AS Slutsky
Hypothermia is widely acknowledged to be the fundamental component of
myocardial protection during cardiac operations. Although it prolongs the
period of ischemic arrest by reducing oxygen demands, hypothermia is
associated with a number of major disadvantages, including its detrimental
effects on enzymatic function, energy generation, and cellular integrity.
We hypothesized that the ideal protected state of the heart would be
electromechanically arrested and perfused with blood, that is, aerobic
arrest. Under these conditions the fundamental need for hypothermia becomes
questionable. We have developed a novel approach to myocardial protection
during cardiac operations based on these concepts, in which the chemically
arrested heart is perfused continuously with blood and maintained at 37
degrees C. In 121 consecutive coronary bypass procedures we have compared
this approach with a historical cohort of 133 consecutive patients treated
with hypothermic cardioplegia. Perioperative myocardial infarction was
significantly less prevalent (1.7% versus 6.8%; p less than 0.05) in the
warm cardioplegic group, as was the use of the intraaortic balloon pump
(0.9% versus 9.0%; p less than 0.005) and the prevalence of low output
syndrome (13.5% versus 3.3%; p less than 0.005). Cardiac output immediately
after bypass was significantly higher than before bypass (3.1 +/- 0.9
versus 4.9 +/- 1.0 L/min; p less than 0.001) only in the warm cardioplegia
group. Furthermore, the heartbeat in 99.2% of patients treated with
continuous warm cardioplegia converted to normal sinus rhythm spontaneously
after removal of the aortic crossclamp compared with only 10.5% of the
hypothermic group. The time from removal of the aortic crossclamp to
discontinuation of cardiopulmonary bypass (i.e., reperfusion time) was
significantly shorter in the warm cardioplegia group (11 +/- 4.3 versus 27
+/- 5.6 minutes; p less than 0.001). Our results suggest that continuous
normothermic blood cardioplegia is safe and effective. Conceptually, this
represents a new approach to the problem of maintaining excellent
myocardial preservation during cardiac operations.
ARTICLES
Warm heart surgery
Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
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A. J. Parry and S. Westaby Cardiopulmonary Bypass During Pregnancy Ann. Thorac. Surg., June 1, 1996; 61(6): 1865 - 1869. [Abstract] [Full Text]
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I. Birdi, M. B. Izzat, A. J. Bryan, and G. D. Angelini Normothermic Techniques During Open Heart Operations Ann. Thorac. Surg., May 1, 1996; 61(5): 1573 - 1580. [Abstract] [Full Text]
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G. Pradas, J. Cuenca, and A. Juffe CONTINUOUS WARM REPERFUSION DURING HEART TRANSPLANTATION J. Thorac. Cardiovasc. Surg., April 1, 1996; 111(4): 784 - 790. [Abstract] [Full Text]
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J. C. Cleveland Jr, D. R. Meldrum, R. T. Rowland, A. Banerjee, and A. H. Harken Optimal Myocardial Preservation: Cooling, Cardioplegia, and Conditioning Ann. Thorac. Surg., February 1, 1996; 61(2): 760 - 768. [Abstract] [Full Text]
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B. K. Podesser, S. Schwarzacher, W. Zwoelfer, T. M. Binder, E. Wolner, and R. Seitelberger COMPARISON OF PERIOPERATIVE MYOCARDIAL PROTECTION WITH NIFEDIPINE VERSUS NIFEDIPINE AND METOPROLOL IN PATIENTS UNDERGOING ELECTIVE CORONARY ARTERY BYPASS GRAFTING J. Thorac. Cardiovasc. Surg., November 1, 1995; 110(5): 1461 - 1469. [Abstract] [Full Text]
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 X. Y. Jin, D. G. Gibson, and J. R. Pepper Early Changes in Regional and Global Left Ventricular Function After Aortic Valve Replacement : Comparison of Crystalloid, Cold Blood, and Warm Blood Cardioplegias Circulation, November 1, 1995; 92(9): 155 - 162. [Abstract] [Full Text]
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P. Menasche, J. Peynet, N. Haeffner-Cavaillon, M.-P. Carreno, T. de Chaumaray, V. Dillisse, B. Faris, A. Piwnica, G. Bloch, and A. Tedgui Influence of Temperature on Neutrophil Trafficking During Clinical Cardiopulmonary Bypass Circulation, November 1, 1995; 92(9): 334 - 340. [Abstract] [Full Text]
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S. V. Lichtenstein, C. D. Naylor, C. M. Feindel, K. Sykora, J. G. Abel, A. S. Slutsky, C. D. Mazer, G. T. Christakis, B. S. Goldman, and S. E. Fremes Intermittent Warm Blood Cardioplegia Circulation, November 1, 1995; 92(9): 341 - 346. [Abstract] [Full Text]
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C. O. Murphy, Pan-Chih, J. P. Gott, and R. A. Guyton Microvascular reactivity after crystalloid, cold blood, and warm blood cardioplegic arrest Ann. Thorac. Surg., October 1, 1995; 60(4): 1021 - 1027. [Abstract] [PDF]
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P. Kaukoranta, M. Lepojarvi, J. Nissinen, P. Raatikainen, and K. J. Peuhkurinen Normothermic versus mild hypothermic retrograde blood cardioplegia: A prospective, randomized study Ann. Thorac. Surg., October 1, 1995; 60(4): 1087 - 1093. [Abstract] [PDF]
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U. Mehlhorn, S. J. Allen, D. L. Adams, K. L. Davis, G. R. Gogola, E. R. de Vivie, and G. A. Laine Normothermic Continuous Antegrade Blood Cardioplegia Does Not Prevent Myocardial Edema and Cardiac Dysfunction Circulation, October 1, 1995; 92(7): 1940 - 1946. [Abstract] [Full Text]
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U. Sprengel, B. Munkel, F. Robicsek, T. N. Masters, and J. Schaper Ischemia affects cardiac proteins in healthy animals less severely than in human patients Ann. Thorac. Surg., September 1, 1995; 60(3): 767 - 772. [Abstract] [PDF]
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G. D. Buckberg Update on current techniques of myocardial protection Ann. Thorac. Surg., September 1, 1995; 60(3): 805 - 814. [Abstract] [PDF]
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M. C. Mauney and I. L. Kron The physiologic basis of warm cardioplegia Ann. Thorac. Surg., September 1, 1995; 60(3): 819 - 823. [Abstract] [PDF]
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J. S. Ikonomidis, V. Rao, R. D. Weisel, N. Hayashida, and T. Shirai Myocardial protection for coronary bypass grafting: The Toronto Hospital perspective Ann. Thorac. Surg., September 1, 1995; 60(3): 824 - 832. [Abstract] [PDF]
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A. S. Abd-Elfattah, M. Ding, and A. S. Wechsler INTERMITTENT AORTIC CROSSCLAMPING PREVENTS CUMULATIVE ADENOSINE TRIPHOSPHATE DEPLETION, VENTRICULAR FIBRILLATION, AND DYSFUNCTION (STUNNING): IS IT PRECONDITIONING? J. Thorac. Cardiovasc. Surg., August 1, 1995; 110(2): 328 - 339. [Abstract] [Full Text]
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A. Ardehali, H. Laks, D. C. Drinkwater Jr, R. N. Gates, and E. Kaczer Ventricular effluent of retrograde cardioplegia in human hearts has traversed capillary beds Ann. Thorac. Surg., July 1, 1995; 60(1): 78 - 83. [Abstract] [PDF]
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I. A. Regragui, M. B. Izzat, I. Birdi, M. Lapsley, A. J. Bryan, and G. D. Angelini Cardiopulmonary bypass perfusion temperature does not influence perioperative renal function Ann. Thorac. Surg., July 1, 1995; 60(1): 160 - 164. [Abstract] [PDF]
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T. Ko, H. Otani, H. Imamura, K. Omori, and C. Inagaki Role of sodium pump activity in warm induction of cardioplegia combined with reperfusion of oxygenated cardioplegic solution J. Thorac. Cardiovasc. Surg., July 1, 1995; 110(1): 103 - 110. [Abstract] [Full Text]
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J. M. Craver, B. L. Bufkin, W. S. Weintraub, and R. A. Guyton Neurologic events after coronary bypass grafting: Further observations with warm cardioplegia Ann. Thorac. Surg., June 1, 1995; 59(6): 1429 - 1434. [Abstract] [PDF]
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C. D. Mazer, A. Hornstein, and J. Freedman Platelet activation in warm and cold heart surgery Ann. Thorac. Surg., June 1, 1995; 59(6): 1481 - 1486. [Abstract] [PDF]
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T. Miyairi, H. Inaba, K. Tanaka, and A. Mizuno Balloon occlusion of the aortic valve for antegrade continuous warm blood cardioplegia Ann. Thorac. Surg., June 1, 1995; 59(6): 1627 - 1627. [PDF]
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J. R. Van Camp, L. A. Brunsting III, K. F. Childs, and S. F. Bolling Functional recovery after ischemia: Warm versus cold cardioplegia Ann. Thorac. Surg., April 1, 1995; 59(4): 795 - 803. [Abstract] [PDF]
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J. Caspi, E. Rudis, I. Bar, T. Safadi, and M. Saute Effects of magnesium on myocardial function after coronary artery bypass grafting Ann. Thorac. Surg., April 1, 1995; 59(4): 942 - 947. [Abstract] [PDF]
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L. A. Robinson, G. D. Schwarz, D. B. Goddard, W. H. Fleming, and T. A. Galbraith Myocardial protection for acquired heart disease surgery: Results of a national survey Ann. Thorac. Surg., February 1, 1995; 59(2): 361 - 372. [Abstract] [PDF]
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A. M. Calafiore, G. Teodori, A. Mezzetti, G. Bosco, A. M. Verna, G. Di Giammarco, and D. Lapenna Intermittent antegrade warm blood cardioplegia Ann. Thorac. Surg., February 1, 1995; 59(2): 398 - 402. [Abstract] [PDF]
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U. Hvass and J.-P. Depoix Clinical study of normothermic cardiopulmonary bypass in 100 patients with coronary artery disease Ann. Thorac. Surg., January 1, 1995; 59(1): 46 - 51. [Abstract] [PDF]
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A. K. Singh, A. A. Bert, W. C. Feng, and F. A. Rotenberg Stroke during coronary artery bypass grafting using hypothermic versus normothermic perfusion Ann. Thorac. Surg., January 1, 1995; 59(1): 84 - 89. [Abstract] [PDF]
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M. Tonz, T. Mihaljevic, L. K. von Segesser, E. R. Schmid, H. I. Doller-Jemelka, P. Pei, and M. I. Turina Normothermia versus hypothermia during cardiopulmonary bypass: A randomized, controlled trial Ann. Thorac. Surg., January 1, 1995; 59(1): 137 - 143. [Abstract] [PDF]
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B. L. Bufkin, R. J. Mellitt, J. P. Gott, A. H. Huang, Pan-Chih, and R. A. Guyton Aerobic blood cardioplegia for revascularization of acute infarct: Effects of delivery temperature Ann. Thorac. Surg., October 1, 1994; 58(4): 953 - 960. [Abstract] [PDF]
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