Warm body, cold heart surgery. Clinical experience in 2817 patients

Systemic hypothermia is used almost universally in cardiac surgery. Since 1987, 2817 patients have had normothermic cardiopulmonary bypass (NCPB, "warm body", bladder temperature 36 degrees C) with cold blood cardioplegic arrest ("cold heart", 8 degrees-14 degrees C) during open heart surgery. No patients were denied this technique regardless of age, condition or severity of surgery. Clinical Characteristics in Patients: Age range: 16-84 years, mean 66; male/female ratio 3:1; pump time (min) 24-183, mean 91; cross-clamp time (min) 15-148, mean 68; types of surgery: coronary artery bypass (n = 2214), valvular (n = 489) and miscellaneous (aneurysms, tumors, arrhythmias, congenital, etc) (n = 114). One thousand and sixty-nine (1069) patients had urgent coronary artery bypass grafting (CABG). The ejection fraction was less than 0.40 in 843 patients (30%). The thirty-day operative mortality for the entire group was 1.7% (48/2817 patients): CABG = 1% (23/2214 patients), valvular = 3% (15/489 patients) and miscellaneous 9% (10/114 patients). Postoperative complications were: perioperative myocardial infarction (34 patients) = 1.2%, postoperative bleeding requiring reexploration (37 patients) = 1.3%, stroke (27 patients) = 1%, and mediastinal infection (21 patients) = 0.7%. During NCPB (WARM) systemic vascular resistance was extremely low, cardiac output was high and it was easier to wean patients from the pump. No intraaortic balloon pump was used during this period. Pulmonary complications and coagulopathy were extremely rare. These results provide reassurance that NCPB (WARM) in combination with cold cardioplegic arrest provides excellent myocardial and total body protection during cardiac surgery and is particularly suitable for high-risk patients.