Warm body, cold heart: myocardial revascularization in 2383 consecutive patients.
Systemic hypothermia is used almost universally in cardiac surgery. Since 1987, 2383 patients underwent normothermic cardiopulmonary bypass (NCPB, "warm body", bladder temperature 36 degrees C) with cold blood cardioplegic arrest ("cold heart", 8-14 degrees C) during myocardial revascularization. No patients were denied this technique regardless of age, condition or severity of surgery. Clinical characteristics in patients: Age range: 31-92 years, mean 66; male/female ratio 3:1; pump time (min): 23-228, mean 80; cross clamp time (min): 18-152, mean 60. One thousand, one hundred and sixty-one patients (49%) had urgent coronary artery bypass grafting (CABG). Ejection fraction was less than 0.4 in 843 patients (30%). Thirty-day operative mortality was 1% (23/2383 patients). Postoperative complications were: perioperative myocardial infarction (35 patients) = 1.5%; postoperative bleeding requiring reexploration (33 patients) = 1.4%; stroke (22 patients) = 0.9%; mediastinal infection (24 patients) = 1%; and renal insufficiency (25 patients) = 1%. During NCPB (warm), systemic vascular resistance was extremely low, cardiac output was high and it was easier to wean patients from the pump. No patient required the intraaortic balloon pump during peri- and post-operative periods. Pulmonary complications and coagulopathy were extremely rare. These results provide reassurance that NCPB (warm) in combination with cold cardioplegic arrest provides excellent myocardial and total body protection during myocardial revascularization and is particularly suitable for high-risk patients.
Singh
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AK
Division of Cardio-Thoracic Surgery, Rhode Island Hospital, Providence.
Feng
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WC
Bert
A A
AA
Rotenberg
F A
FA
D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D002315:Cardiopulmonary Bypass / Q000379:methods / Q000401:mortality; D002423:Cause of Death; D004562:Electrocardiography; D004630:Emergencies; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods / Q000401:mortality; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality