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European Journal of Cardio-Thoracic Surgery, Vol 7, 225-229, Copyright © 1993 by European Association for Cardio-thoracic Surgery
AK Singh, WC Feng, AA Bert and FA Rotenberg
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.
ARTICLES
Warm body, cold heart surgery. Clinical experience in 2817 patients
Rhode Island Hospital, Providence 02903.
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