[Repeat open heart surgery using continuous warm blood cardioplegia]

Myocardial protection during repeat open heart surgery still remains to be further improved. The purpose of this study was to evaluate the usefulness of continuous warm blood cardioplegia (CWBC) comparing with intermittent cold GIK cardioplegia (ICGC) in repeat open heart surgery. Twenty-four patients underwent repeat open heart surgery through re-sternotomy (11 mitral, 6 aortic 5 double, 2 congenital) were divided into two groups, that is 10 received CWBC (warm group) and 14 ICGC (Cold group). Spontaneous recovery of heart beat was obtained in 9 of 10 patients (90.0%) in warm group, in contrast only 2 of 14 (14.3%) in cold group (p < 0.001) following aortic declamping. Postoperative peak level of serum CK-MB in warm group (25.9 +/- 7.4 IU/l) was significantly lower than that (83.1 +/- 24.6) in cold group. In warm group left and right ventricular stroke work index significantly increased at 24 hours postoperatively, whereas no significant increase was found in cold group. Postoperative bleeding in the first 24 hours was less (553.8 +/- 38.9 ml) in warm group than that (974.3 +/- 54.1 ml) in cold group. In warm group 3 patients were operated on without homologous blood transfusion, in contrast none in cold group. Our results clearly demonstrated that CWBC was preferable to ICGC for myocardial protection in repeat open heart surgery.