Myocardial protection during coronary surgery. Getting the maximum advantage of both cardioplegia and hypothermia

The author presents a specially timed protocol of a combination of cold cardioplegic arrest and deep total body hypothermia designed to include the best features and to eliminate some of the principal short-comings of these 2 commonly used methods of myocardial preservation. According to this protocol, the operations were divided into 3 periods: (1) About half the number of the peripheral anastomoses are done in the first period while the body is cooled to 20 degrees C and the during which the heart is in cold ischemic cardioplegic arrest. (2) Most or all proximal anastomoses are done in the second period during which body temperature is kept at 20 degrees C and the heart is in a per vias naturales perfused cold arrest. (3) During the third period, the remaining anastomoses are completed while the heart is again in cold ischemic cardioplegic arrest and the body is rewarmed. This method was used in excess of 100 myocardial revascularization procedures with satisfactory clinical results.