Myocardial protection of cold crystalloid and warm blood cardioplegia. A comparative study

Twenty patients undergoing open-heart valvular operations were divided randomly into two groups. Intermittent perfusion of cold crystalloid (St. Thomas Hospital solution) with hypothermic cardiopulmonary bypass (CPB) in the hypothermic group and continuous administration of warm blood cardioplegia with normothermic CPB in the normothermic group were used respectively. The results of warm blood cardioplegia were superior to those of cold crystalloid. 70% of patients treated with the warm technique had spontaneous return of normal sinus rhythm shortly after removal of the aortic cross-clamp, compared with only 10% of the hypothermic group (P < 0.05). The extracorporeal support time from releasing of aortic clamp to the weaning of CPB was significantly shorter in the normothermic group (33.50 +/- 3.78 min vs. 25.00 +/- 4.64 min, P < 0.05). The postoperative ventilation support time was also much shorter than that of the hypothermic group (19.84 +/- 1.11 h vs. 38.98 +/- 16.55 h, P < 0.05). More atrial beating occurred in the normothermic group (80% vs. 20%, P < 0.05) during aortic clamping, and it is showed that continuous warm blood cardioplegia might not efficiently prevent the atrium from damage.