Selective intracavitary and coronary profound hypothermic cardioplegia for myocardial preservation: a new technique

A technique is described for selective intracavitary and coronary hypothermic perfusion during cardiac bypass with cardioplegia to facilitate cardiac operations. A cold perfusate (Plasmalyte 148 and mannitol, 12.5 gm/L at 8 degrees to 10 degrees C) is administered with the aid of a low-flow perfusion pump into the left ventricular cavity and coronary circulation through an apical perfusion-venting (Per-Vent) catheter. This perfusate cools the myocardium rapidly and homogeneously to a temperature of 15 degrees to 20 degrees C. Within this temperature range, complete cardioplegia occurs and the safe ischemia period can be extended to 120 minutes. This method was applied in 50 unselected consecutive adult patients undergoing aortocoronary saphenous vein bypass grafting or aortic or mitral valve replacement. All patients survived and had excellent recovery of ventricular function.