The warm versus cold perfusion controversy: a clinical comparative study

Area of Science:

• Cardiovascular Surgery
• Cardiac Anesthesia
• Cardiopulmonary Bypass

Background:

• Maintaining myocardial and total body protection during cardiac surgery is crucial.
• Continuous cardioplegia (Cp) is a common method used during cardiopulmonary bypass (CPB).
• The impact of temperature variations in CPB and Cp on patient outcomes requires further investigation.

Purpose of the Study:

• To evaluate the effects of different temperature strategies during cardiopulmonary bypass (CPB) and continuous cardioplegia (Cp) on myocardial protection.
• To assess the influence of normothermic versus hypothermic CPB on total body protection and postoperative recovery.
• To compare outcomes in patients undergoing coronary artery bypass grafting, valve replacement, or both.

Main Methods:

• A retrospective analysis of 129 patients undergoing cardiac surgery with continuous cardioplegia (Cp).
• Patients were divided into three groups: Group I (normothermic CPB and warm Cp), Group II (normothermic CPB and cold Cp), and Group III (hypothermic CPB and cold Cp).
• Outcomes assessed included serum enzyme levels (creatine kinase, amylase, lactate dehydrogenase), creatinine, perioperative myocardial infarction, need for mechanical support, and mortality.

Main Results:

• No significant differences were observed in myocardial protection, indicated by serum creatine kinase (CK) levels, perioperative myocardial infarction rates, need for intra-aortic balloon pump or inotropic support, and mortality between the groups.
• Comparison between normothermic CPB and hypothermic CPB showed similar levels of CK, amylase, lactate dehydrogenase, and creatinine postoperatively.
• Normothermic cardiopulmonary bypass (CPB) was associated with significantly shorter bypass times and earlier extubation compared to hypothermic CPB.

Conclusions:

• Temperature management during cardiopulmonary bypass (CPB) with continuous cardioplegia (Cp) does not appear to affect myocardial protection.
• Normothermic CPB, compared to hypothermic CPB, leads to a shorter perfusion time and a faster postoperative recovery course.
• These findings suggest that normothermic CPB may offer advantages in terms of surgical efficiency and patient recovery without compromising myocardial protection.