A randomized study of the systemic effects of warm heart surgery.
The technique of warm heart surgery is defined as continuous warm blood cardioplegia and normothermic cardiopulmonary bypass. Although the systemic effects of traditional myocardial protection are well known, the effects of warm heart surgery are not. In a prospective trial, 204 patients undergoing coronary artery bypass grafting were randomized to the warm heart surgery technique (normothermic group) or traditional intermittent cold blood cardioplegia and cardiopulmonary bypass (hypothermic group). The groups had similar heparin sodium requirement, activated clotting times, urine output, hematocrit, and blood product utilization. There were no differences in hemodynamics immediately after cardiopulmonary bypass. The normothermic patients had a higher incidence of spontaneous defibrillation at cross-clamp removal (84%) than the hypothermic patients (33%) (p less than 0.01). An increase in the flow rate of low K+ cardioplegia was necessary to eradicate electrical activity during aortic occlusion more often in the normothermic patients (20%) than in the hypothermic patients (3%) (p less than 0.01). When low K+ cardioplegia was ineffective, high K+ cardioplegia was necessary to eradicate electrical activity in 31% of the normothermic patients compared with 10% of the hypothermic patients (p less than 0.05). The total cardioplegia volume delivered to the normothermic group (4.7 +/- 1.9 L) was higher than that delivered to the hypothermic group (2.6 +/- 0.8 L) (p less than 0.01). Although urine output was similar in both groups, the serum K+ levels were higher in the normothermic group (5.7 +/- 0.8 mmol/L) than in the hypothermic group (5.3 +/- 0.8 mmol/L) (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Christakis
G T
GT
Department of Anesthesia, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.
Koch
J P
JP
Deemar
K A
KA
Fremes
S E
SE
Sinclair
L
L
Chen
E
E
Salerno
T A
TA
Goldman
B S
BS
Lichtenstein
S V
SV
D001794:Blood Pressure; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods*; D005440:Fluid Therapy; D006321:Heart / Q000503:physiopathology; D006324:Heart Arrest, Induced / Q000379:methods; D006439:Hemodynamics; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007431:Intraoperative Complications; D011188:Potassium / Q000008:administration & dosage / Q000097:blood; D011446:Prospective Studies; D013696:Temperature; D014556:Urine
D006493:Heparin; D011188:Potassium