Myocardial protection with cold, ischemic, potassium-induced cardioplegia

A total of 204 patients, ages 3 months to 84 years, underwent open-heart surgery with the aid of cardiopulmonary bypass with moderate hypothermia. For protection of the myocardium, cardioplegia was induced by washing out the coronary arteries with an iced, buffered, isoosmolar, potassium-based infusate. After aortic cross-clamping, the aortic root or individual coronary arteries were perfused with 500 to 2,000 c.c. of an aqueous solution (at zero to 4 degrees C.) containing 20 mEq. of potassium. Periods of ischemic arrest as long as 208 minutes have been well tolerated, with only two of the eleven hospital deaths considered heart related. Defibrillation occurred spontaneously in 41 per cent and after one shock in 47 per cent of patient, without apparent correlation between duration of ischemia and restoration of effective rhythm.