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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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L. M. Jacquet, P. H. Noirhomme, M. J. Van Dyck, G. A. El Khoury, A. J. Matta, M. J. Goenen, and R. A. Dion Randomized trial of intermittent antegrade warm blood versus cold crystalloid cardioplegia Ann. Thorac. Surg., February 1, 1999; 67(2): 471 - 477. [Abstract] [Full Text] [PDF]
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A. C. Fiore, M. T. Swartz, R. Nevett, P. J. Vieth, R. A. Magrath, A. Sherrick, and H. B. Barner Intermittent Antegrade Tepid Versus Cold Blood Cardioplegia in Elective Myocardial Revascularization Ann. Thorac. Surg., June 1, 1998; 65(6): 1559 - 1564. [Abstract] [Full Text] [PDF]
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C. T. Wass, J. W. III, D. G. Cable, H. V. Schaff, D. R. Schroeder, and W. L. Lanier Selective convective brain cooling during normothermic cardiopulmonary bypass in dogs J. Thorac. Cardiovasc. Surg., June 1, 1998; 115(6): 1350 - 1357. [Abstract] [Full Text] [PDF]
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W. V. Houck, S. B. Kribbs, J. L. Zellner, M. A. Doscher, J. D. Joshi, F. A. Crawford Jr, and F. G. Spinale Normothermic Versus Hypothermic Hyperkalemic Cardioplegia: Effects on Myocyte Contractility Ann. Thorac. Surg., May 1, 1998; 65(5): 1279 - 1283. [Abstract] [Full Text] [PDF]
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B.-L. Liam, W. Plochl, D. J. Cook, T. A. Orszulak, and R. C. Daly Hemodilution and whole body oxygen balance during normothermiccardiopulmonary bypass in dogs J. Thorac. Cardiovasc. Surg., May 1, 1998; 115(5): 1203 - 1208. [Abstract] [Full Text] [PDF]
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N. Hayashida, T. Isomura, T. Sato, H. Maruyama, T. Higashi, K. Arinaga, and S. Aoyagi Minimally Diluted Tepid Blood Cardioplegia Ann. Thorac. Surg., March 1, 1998; 65(3): 615 - 621. [Abstract] [Full Text] [PDF]
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F. P. Tritto, J. Inserte, D. Garcia-Dorado, M. Ruiz-Meana, and J. Soler-Soler Sodium/Hydrogen Exchanger Inhibition Reduces Myocardial Reperfusion Edema After Normothermic Cardioplegia J. Thorac. Cardiovasc. Surg., March 1, 1998; 115(3): 709 - 715. [Abstract] [Full Text] [PDF]
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N. C. de Oliveira, T. J. Boeve, D. F. Torchiana, H. L. Kantor, J. S. Titus, C. J. Schmidt, C.-z. Lu, J. Kim, W. M. Daggett, and G. A. Geffin ISCHEMIC INTERVALS DURING WARM BLOOD CARDIOPLEGIA IN THE CANINE HEART EVALUATED BY PHOSPHORUS 31-MAGNETIC RESONANCE SPECTROSCOPY J. Thorac. Cardiovasc. Surg., December 1, 1997; 114(6): 1070 - 1080. [Abstract] [Full Text]
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M. Tofukuji, A. Stamler, J. Li, M. D. Hariawala, A. Franklin, and F. W. Sellke Comparative Effects of Continuous Warm Blood and Intermittent Cold Blood Cardioplegia on Coronary Reactivity Ann. Thorac. Surg., November 1, 1997; 64(5): 1360 - 1367. [Abstract] [Full Text]
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T. Ohata, Y. Sawa, K. Kadoba, T. Masai, H. Ichikawa, and H. Matsuda Effect of Cardiopulmonary Bypass Under Tepid Temperature on Inflammatory Reactions Ann. Thorac. Surg., July 1, 1997; 64(1): 124 - 128. [Abstract] [Full Text]
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P. J. Lin, C.-H. Chang, C.-W. Hsiao, Y. Chu, H.-P. Liu, H.-C. Hsieh, K.-T. Tsai, M.-J. Hsieh, Y.-Y. Chou, and Y.-S. Lee CONTINUOUS ANTEGRADE WARM BLOOD CARDIOPLEGIA ATTENUATES AUGMENTED CORONARY ENDOTHELIUM-DEPENDENT CONTRACTION AFTER CARDIAC GLOBAL ISCHEMIA AND REPERFUSION J. Thorac. Cardiovasc. Surg., July 1, 1997; 114(1): 100 - 108. [Abstract] [Full Text]
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M. Chello, P. Mastroroberto, V. De Amicis, D. Pantaleo, R. Ascione, and N. Spampinato Intermittent Warm Blood Cardioplegia Preserves Myocardial {beta}-Adrenergic Receptor Function Ann. Thorac. Surg., March 1, 1997; 63(3): 683 - 688. [Abstract] [Full Text]
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A. Kamlot, S. D. Bellows, B. Z. Simkhovich, S. L. Hale, A. Aoki, R. A. Kloner, and G. L. Kay Is Warm Retrograde Blood Cardioplegia Better Than Cold for Myocardial Protection? Ann. Thorac. Surg., January 1, 1997; 63(1): 98 - 104. [Abstract] [Full Text]
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D. W Fried, J. J Leo, G. J Mattioni, H. Mohamed, T. L Zombolas, and S. J Weiss Warm cardiac surgery with continuous blood cardioplegia using a potassium infusion pump Perfusion, January 1, 1997; 12(1): 21 - 26. [PDF]
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X.-H. Ning, Keith.F. Childs, and S. F. Bolling Glucose Level and Myocardial Recovery After Warm Arrest Ann. Thorac. Surg., December 1, 1996; 62(6): 1825 - 1829. [Abstract] [Full Text]
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L. Torracca, E. Pasini, S. Curello, C. Ceconi, G. Coletti, O. Alfieri, R. Solfrini, and R. Ferrari Continuous Versus Intermittent Warm Blood Cardioplegia: Functional and Energetics Changes Ann. Thorac. Surg., October 1, 1996; 62(4): 1172 - 1179. [Abstract] [Full Text]
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