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Ann Thorac Surg 1989;47:788-791
© 1989 The Society of Thoracic Surgeons

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Articles

Hypothermia: Its possible role in cardiac surgery

Sanger Clinic, Charlotte, North Carolina, and Mercer University School of Medicine and Medical Center of Central Georgia, Macon, Georgia, USA

^_* Address reprint requests to Dr Sealy, Department of Surgery, Medical Center of Central Georgia, 777 Hemlock St, PO Box 6000, Macon, GA 31208.

The current safety of operations on the heart requiring cardiopulmonary bypass occurred because of a series of step-by-step laboratory and clinical investigations that were compromises between the time needed for heart repair and the brain's requirement for oxygen. The first step, so clearly shown in a paper by Bigelow and associates in 1950, was the reduction of the brain's need for oxygen by surface cooling to 28 ° to 32 °C, limited to this level by cardiac and pulmonary failure at levels lower than this. The six to eight minutes of circulatory arrest permitted time for repair of simple defects. This method was rapidly adopted by many surgeons. As low-flow pump oxygenators became available, blood cooling to 10 ° to 20 °C was introduced. This increased the periods of circulatory arrest to 30 to 60 minutes, and also made still longer periods of bypass with the pump oxygenator possible. Hypothermia to reduce oxygen and metabolic requirements is still an important adjunct to bypass, even with the currently used efficient pump oxygenators. It remains the most important component of mycardial preservation, and has made possible the delay needed for transportation between the harvesting and the transplantation of organs.

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