Does hypothermic fibrillatory arrest improve myocardial protection during emergency revascularization?

Hypothermic fibrillatory arrest (HFA) was compared with conventional hypothermic cardioplegic arrest (HCA) in a model of acute regional ischemia. In 20 pigs, the left anterior descending coronary artery was occluded for 30 minutes before cardiopulmonary bypass. In the HCA group (n = 10), the heart was arrested with a hyperkalemic cold crystalloid solution, whereas in HFA animals (n = 10), the heart was vented and allowed to fibrillate spontaneously without cross-clamping. Miniature pH probes monitored intramyocardial pH during 45 minutes of arrest (HCA or HFA, both with systemic and topical myocardial cooling) and during two hours of coronary reperfusion. Hypothermic fibrillatory arrest did not ameliorate the acidosis in the ischemic (left anterior descending) region; indeed, after two hours of coronary reperfusion, there was a trend toward more acidosis in the postischemic left anterior descending territory in the HFA group. However, HFA did prevent acidosis in the nonischemic (left circumflex) territory. Infarct size expressed as percent of region at risk was 18.1% +/- 3.2% (mean +/- standard error of the mean) in the HCA animals and 18.8% +/- 4.4% in the HFA animals. These results demonstrate that HFA offers no advantage over HCA in protection of regionally ischemic myocardium in a model with minimal collateral circulation.