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The Annals of Thoracic Surgery, Vol 57, 298-302, Copyright © 1994 by The Society of Thoracic Surgeons
TD Martin, JM Craver, JP Gott, WS Weintraub, J Ramsay, CT Mora and RA Guyton
From March 1991 through July 1992, 1,001 patients having elective coronary
artery bypass grafting were randomized to receive either continuous warm
(> or = 35 degrees C) blood cardioplegia with systemic normothermia
(> or = 35 degrees C) or intermittent cold (< or = 8 degrees C)
oxygenated crystalloid cardioplegia and moderate systemic hypothermia (<
or = 28 degrees C). Preoperative variables including age, sex, prior
coronary bypass grafting, hypertension, prior myocardial infarction,
diabetes, angina class, and preoperative heart failure class were similar
in both groups, as were the intraoperative variables of number of coronary
grafts, mammary artery use, and cardiopulmonary bypass time. Aortic
cross-clamp time was significantly longer in the warm group (46 +/- 23
minutes versus 40 +/- 21 minutes). Most postoperative variables including
mortality (warm, 1.0%, and cold, 1.6%), Q wave infarction (warm, 1.4%, and
cold, 0.8%), and need of an intraaortic balloon pump (warm, 1.4%, and cold,
2.0%) were similar between groups. Total neurologic events (warm, 4.5%, and
cold, 1.4%; p < 0.005) and perioperative strokes (warm, 3.1%, and cold,
1.0%; p < or = 0.02) were significantly higher in the warm group.
Neurologic events included perioperative stroke (warm, 15 patients, and
cold, 5 patients; p < 0.02), perioperative encephalopathy (warm, 2
patients, and cold, 1 patient), and delayed (> or = 3 in-hospital days)
stroke (warm, 5 patients, and cold, 1 patient). All patients experiencing a
stroke had a persistent neurologic deficit at the time of discharge.
Encephalopathy resolved completely in all instances.(ABSTRACT TRUNCATED AT
250 WORDS)
ARTICLES
Prospective, randomized trial of retrograde warm blood cardioplegia: myocardial benefit and neurologic threat
Emory University School of Medicine, Atlanta, Georgia.
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