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Ann Thorac Surg 1977;24:330-336
© 1977 The Society of Thoracic Surgeons

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Articles

Continuous Hypothermic Arrest Versus Intermittent Ischemia for Myocardial Protection During Coronary Revascularization

Departments of Surgery and Medicine, Harvard Medical School and Peter Bent Brigham Hospital, Boston, MA.

^* Address reprint requests to Dr. Koster, Peter Bent Brigham Hospital, 721 Huntington Ave, Boston, MA 02115

To assess the safety of two commonly used methods of myocardial protection, 144 consecutive patients who underwent coronary artery bypass grafting for chronic disabling or unstable angina were studied. Profound local cardiac hypothermia (LCH) with a single continuous period of ischemic arrest was used in 71 patients and compared with intermittent ischemia with intervening periods of reperfusion in 73 patients. Both groups were similar in age, sex distribution, number of obstructed coronary arteries, and number of coronary arterial bypass grafts performed. The electrocardiogram, serum glutamic oxaloacetic transaminase (SGOT), lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were measured preoperatively, the day of operation, and for two days postoperatively. The operative mortality was 0.7%. The overall perioperative myocardial infarction rate defined by QRS criteria was 6.3%. In the LCH group the infarction rate was 4.2%, and in the ischemia group, 8.2%. Although mean initial postoperative SGOT and LDH were noticeably lower in the LCH group, other enzyme values, including CPK, did not differ noticeably between the groups. These data indicate that a single continuous period of ischemic arrest with profound local cardiac hypothermia as well as intermittent aortic cross-clamping with moderate systemic hypothermia are safe techniques for protecting the myocardium during coronary revascularization.

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