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Warm heart surgery.

S V Lichtenstein¹, K A Ashe, H el Dalati

¹Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.

The Journal of Thoracic and Cardiovascular Surgery

|February 1, 1991

Summary

This study introduces a new method for heart protection during surgery using warm blood cardioplegia, showing it reduces heart damage and improves recovery compared to traditional cold methods.

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Area of Science:

Cardiovascular Surgery
Cardiac Anesthesia
Myocardial Protection

Background:

Hypothermia is standard for myocardial protection but has drawbacks affecting cellular function.
The need for hypothermia is questioned under aerobic arrest conditions.
A novel approach using normothermic aerobic arrest was developed.

Purpose of the Study:

To evaluate the safety and efficacy of continuous normothermic blood cardioplegia.
To compare this novel approach with traditional hypothermic cardioplegia during coronary bypass surgery.

Main Methods:

A prospective study comparing 121 patients receiving warm cardioplegia with 133 historical controls receiving hypothermic cardioplegia.
Both groups underwent coronary bypass procedures.

Main Results:

The warm cardioplegia group showed significantly lower rates of perioperative myocardial infarction (1.7% vs. 6.8%) and low output syndrome (3.3% vs. 13.5%).
Higher post-bypass cardiac output and spontaneous conversion to normal sinus rhythm (99.2% vs. 10.5%) were observed in the warm cardioplegia group.
Reperfusion time was significantly shorter in the warm cardioplegia group (11 min vs. 27 min).

Conclusions:

Continuous normothermic blood cardioplegia is a safe and effective alternative for myocardial preservation.
This technique represents a significant conceptual advancement in cardiac surgical protection.
The findings challenge the necessity of hypothermia in certain cardiac operations.

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