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J Thorac Cardiovasc Surg 1996;112:1622-1633
© 1996 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

WHAT IS THE BEST PERFUSION TEMPERATURE FOR CORONARY REVASCULARIZATION?

Supported by National Institutes of Health grant No. 1R01 HL 48631-02.

Received for publication May 6, 1996 Revisions requested June 18, 1996; revisions received July 12, 1996 Accepted for publication July 15, 1996. Address for reprints: Richard M. Engelman, MD, Baystate Medical Center, 759 Chestnut St., Springfield, MA 01107.

Abstract

Background: A National Institutes of Health–funded clinical trial of patients undergoing coronary artery bypass randomized perfusate and myocardial preservation to cold, tepid, or warm temperatures. The goal of the trial was to evaluate neurologic function before and after operation (4 days and 1 month after operation) and to measure hematologic data for fibrinolytic potential.
Methods: The three groups comprised 116 patients who completed neurologic evaluation by means of the Mathew scale out of 130 entered into the trial (37 cold group, 50 tepid, and 43 warm). Twenty-five patients had complete hematologic studies done. All three groups were comparable before operation. The myocardial preservation protocol used blood cardioplegic solution at cold (8º to 10º C), tepid (32º C), or warm (37º C) temperature and the systemic perfusate temperature during cardiopulmonary bypass was 20º (cold), 32º C (tepid), or 37º C (warm).
Results: Patients in the cold group had a longer duration of intubation and postoperative hospitalization and a slightly but significantly higher peak postoperative creatine kinase MB level than patients in the warm group. There were no deaths. There was deterioration in Mathew scale findings in all three groups, and no distinction could be made between groups. However, a significantly higher number in the cold group had an abnormal postoperative neurologic examination result that prompted computed tomographic scanning (18.9% cold, 2% tepid, 9.3% warm). A cerebrovascular accident was documented by computed tomographic scanning in 8.1%, 0%, and 4.7% of patients in the cold, tepid, and warm groups, respectively (not significant). Hematologic data documented significantly increased fibrinolytic potential in the warm group.
Conclusions: Perfusion temperature is a factor in recovery from cardiopulmonary bypass. Cold has more adverse neurologic sequelae that prompt computed tomographic scanning whereas warm has more activation of fibrinolytic potential. Tepid is the best temperature for optimizing recovery from cardiopulmonary bypass. (J THORAC CARDIOVASC SURG 1996;112:1622-33)

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