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Neurologic events after coronary bypass grafting: further observations with warm cardioplegia
J M Craver1, B L Bufkin, W S Weintraub
1Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Moderately hypothermic aerobic heart surgery offers myocardial protection similar to warm heart surgery but significantly reduces the risk of neurologic events. This approach is a safer alternative for coronary artery bypass graft operations.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Anesthesiology
Background:
- Warm heart surgery provides myocardial protection but increases neurologic risk.
- Hypothermic aerobic heart surgery aims to maintain myocardial protection while reducing neurologic complications.
Purpose of the Study:
- To compare the efficacy and safety of moderately hypothermic versus normothermic aerobic heart surgery.
- To evaluate myocardial protection and neurologic risk in patients undergoing coronary artery bypass graft (CABG) operations.
Main Methods:
- A comparative study involving 493 patients undergoing normothermic CABG and 379 patients undergoing hypothermic CABG.
- Continuous blood cardioplegia and perfusion were used, with temperatures maintained at 35–37°C for normothermic and 29–33°C for hypothermic groups.
- Patient demographics and clinical characteristics were analyzed, alongside postoperative outcomes.
Main Results:
- No significant difference in postoperative myocardial infarction rates between hypothermic (1.2%) and normothermic (1.3%) groups.
- The hypothermic group showed a trend towards higher intraaortic balloon pump requirement (3.4% vs. 1.4%).
- The incidence of postoperative neurologic events was significantly lower in the hypothermic group (1.8% vs. 4.7%).
Conclusions:
- Moderately hypothermic aerobic heart surgery maintains myocardial protection comparable to normothermic techniques.
- Hypothermic aerobic heart surgery significantly reduces the incidence of postoperative neurologic events compared to normothermic surgery.
- Older age and normothermic cardioplegia were identified as multivariate correlates of stroke.
Abstract:
Warm heart surgery has documented myocardial protection benefit, but with an added neurologic threat. It is hypothesized that moderately hypothermic aerobic heart surgery will maintain the myocardial protection and reduce neurologic risk. This study compared 493 patients undergoing coronary artery bypass graft operations with normothermic (35 degrees to 37% degrees C) continuous blood cardioplegia and normothermic perfusion to 379 coronary artery bypass grafting patients with hypothermic (33 degrees to 29 degrees C) continuous blood cardioplegia and hypothermic perfusion to test this hypothesis. There was no difference in age, sex, prior myocardial infarction, hypertension, prior neurologic event, congestive failure, or diabetes. The hypothermic group had more reoperations (24% versus 14%; p = 0.0002), class III/IV angina (83% versus 71%; p = 0.002), a trend to more triple-vessel (54% versus 47%; p = 0.10) and left main disease (18% versus 14%; p = 0.10), lower ejection fractions (0.52 +/- 0.15 versus 0.55 +/- 0.13), more grafts placed (3.6 +/- 1.1 versus 3.4 +/- 1.1; p = 0.04), but fewer internal mammary arteries (62% versus 78%; p < 0.0001). Postoperative myocardial infarction rate was 1.2% in the hypothermic group and 1.3% in the normothermic group (p = not significant). Intraaortic balloon pump requirement was 3.4% with hypothermic and 1.4% with normothermic groups (p = 0.05). The incidence of postoperative neurologic events was significantly higher in the normothermic group (4.7% versus 1.8%; p = 0.038). The multivariate correlates of stroke were older age and normothermic cardioplegia, whereas the only multivariate correlate of death was older age.(ABSTRACT TRUNCATED AT 250 WORDS)