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Related Experiment Videos

Normothermic ischemia in coronary revascularization

S V Lichtenstein1, J G Abel, S E Fremes

  • 1Division of Cardiovascular and Thoracic Surgery, St. Paul's Hospital Heart Centre, University of British Columbia, Vancouver, Canada.

Annals of the New York Academy of Sciences
|September 30, 1996
PubMed
Summary

Warm heart surgery using intermittent normothermic blood cardioplegia is safe for coronary artery bypass grafting. Limiting single ischemic intervals to under 13 minutes may protect the heart during these procedures.

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Area of Science:

  • Cardiovascular Surgery
  • Cardiac Anesthesia
  • Myocardial Protection

Background:

  • Warm heart surgery with continuous normothermic blood cardioplegia offers an alternative to hypothermic methods for myocardial protection.
  • Interruption of coronary flow during surgery facilitates distal coronary anastomoses, a common practice in coronary revascularization.

Purpose of the Study:

  • To evaluate the safety and efficacy of intermittent warm blood cardioplegia during coronary artery bypass grafting in a large patient cohort.
  • To determine the impact of specific cardioplegia interruption parameters on patient outcomes.

Main Methods:

  • Analysis of 720 patients undergoing coronary artery bypass surgery with intermittent warm blood cardioplegia and electromechanical arrest.
  • Measurement of aortic cross-clamp time, total cardioplegia interruption time, and longest single time off cardioplegia (LTOC).

Related Experiment Videos

  • Correlation of percent time off cardioplegia (PTOC) and LTOC quartiles with a composite outcome of mortality, myocardial infarction, and low output syndrome.

    • Main Results:

    • An average of 3.2 grafts were constructed with a mean aortic cross-clamp time of 61.8 minutes.
    • The mean total time off cardioplegia was 28.5 minutes, representing 48.2% of the cross-clamp time.
    • While increased PTOC showed a protective trend (p=0.07), longer LTOC (p=0.046) was borderline harmful, with intervals < 13 minutes associated with better outcomes.

    Conclusions:

    • Intermittent normothermic myocardial ischemia with electromechanical arrest is well-tolerated in coronary artery bypass surgery.
    • Limiting single periods of ischemia to less than 13 minutes appears to be protective against adverse outcomes.
    • These findings support the judicious use of warm blood cardioplegia in complex coronary revascularization procedures.