HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Craver, J. M. Articles by Guyton, R. A. Search for Related Content PubMed PubMed Citation Articles by Craver, J. M. Articles by Guyton, R. A.

Ann Thorac Surg 1995;59:1429-1433
© 1995 The Society of Thoracic Surgeons

Neurologic Events After Coronary Bypass Grafting: Further Observations With Warm Cardioplegia

Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia

Warm heart surgery has documented myocardial protection benefit, but with an added neurologic threat. It is hypothesized that moderately hypothermic aerobic heart surgery will maintain the myocardial protection and reduce neurologic risk. This study compared 493 patients undergoing coronary artery bypass graft operations with normothermic (35° to 37°C) continuous blood cardioplegia and normothermic perfusion to 379 coronary artery bypass grafting patients with hypothermic (33° to 29°C) continuous blood cardioplegia and hypothermic perfusion to test this hypothesis. There was no difference in age, sex, prior myocardial infarction, hypertension, prior neurologic event, congestive failure, or diabetes. The hypothermic group had more reoperations (24% versus 14%; p = 0.0002), class III/IV angina (83% versus 71%; p = 0.002), a trend to more triple-vessel (54% versus 47%; p = 0.10) and left main disease (18% versus 14%; p = 0.10), lower ejection fractions (0.52 ± 0.15 versus 0.55 ± 0.13), more grafts placed (3.6 ± 1.1 versus 3.4 ± 1.1; p = 0.04), but fewer internal mammary arteries (62% versus 78%; p < 0.0001). Postoperative myocardial infarction rate was 1.2% in the hypothermic group and 1.3% in the normothermic group (p = not significant). Intraaortic balloon pump requirement was 3.4% with hypothermic and 1.4% with normothermic groups (p = 0.05). The incidence of postoperative neurologic events was significantly higher in the normothermic group (4.7% versus 1.8%; p = 0.038). The multivariate correlates of stroke were older age and normothermic cardioplegia, whereas the only multivariate correlate of death was older age. In summary, these data suggest that hypothermic continuous blood cardioplegia provides myocardial protection that is equivalent to normothermic continuous blood cardioplegia, whereas hypothermic aerobic heart surgery may lessen the neurologic risk that was observed associated with strict warm heart surgery.

This article has been cited by other articles:

				H. Kaukuntla, A. Walker, D. Harrington, T. Jones, and R. S. Bonser Differential brain and body temperature during cardiopulmonary bypass--a randomised clinical study Eur. J. Cardiothorac. Surg., September 1, 2004; 26(3): 571 - 579. [Abstract] [Full Text] [PDF]

				H. Kaukuntla, D. Harrington, I. Bilkoo, T. Clutton-Brock, T. Jones, and R. S. Bonser Temperature monitoring during cardiopulmonary bypass--do we undercool or overheat the brain? Eur. J. Cardiothorac. Surg., September 1, 2004; 26(3): 580 - 585. [Abstract] [Full Text] [PDF]

				K. V. Arom and F. L. Grover Adult cardiac surgery during the first 50 years of the Southern Thoracic Surgical Association Ann. Thorac. Surg., November 1, 2003; 76(90050): S17 - 46. [Abstract] [Full Text] [PDF]

				H. R. Mallidi, J. Sever, M. Tamariz, S. Singh, N. Hanayama, G. T. Christakis, G. Bhatnagar, C. A. Cutrara, B. S. Goldman, and S. E. Fremes The short-term and long-term effects of warm or tepid cardioplegia J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(3): 711 - 720. [Abstract] [Full Text] [PDF]

				D. J. Cook, T. A. Orszulak, K. J. Zehr, N. A. Nussmeier, J. J. Livesay, J. W. Hammon, and X. Chen Effectiveness of the Cobra aortic catheter for dual-temperature management during adult cardiac surgery J. Thorac. Cardiovasc. Surg., February 1, 2003; 125(2): 378 - 384. [Abstract] [Full Text] [PDF]

				P. W.M. Fedak, N. Mamalias, and R. D. Weisel Invited commentary Ann. Thorac. Surg., December 1, 2002; 74(6): 2160 - 2160. [Full Text] [PDF]

				M. Gaudino, R. Zamparelli, F. Andreotti, F. Burzotta, L. Iacoviello, F. Glieca, M. B. Donati, A. Maseri, R. Schiavello, and G. Possati Normothermia does not improve postoperative hemostasis nor does it reduce inflammatory activation in patients undergoing primary isolated coronary artery bypass J. Thorac. Cardiovasc. Surg., June 1, 2002; 123(6): 1092 - 1100. [Abstract] [Full Text] [PDF]

				J. M. Slater, T. A. Orszulak, K. J. Zehr, and D. J. Cook Use of the Cobra catheter for targeted temperature management during cardiopulmonary bypass in swine J. Thorac. Cardiovasc. Surg., May 1, 2002; 123(5): 936 - 942. [Abstract] [Full Text] [PDF]

				Z. S. Meharwal, A. Mishra, and N. Trehan Safety and efficacy of one stage off-pump coronary artery operation and carotid endarterectomy Ann. Thorac. Surg., March 1, 2002; 73(3): 793 - 797. [Abstract] [Full Text] [PDF]

				C. D. Morris, J. M. Budde, D. A. Velez, S. Muraki, Z.-Q. Zhao, J. D. Puskas, R. A. Guyton, and J. Vinten-Johansen Electroplegia: an alternative to blood cardioplegia for arresting the heart during conventional (on-pump) cardiac operation Ann. Thorac. Surg., September 1, 2001; 72(3): 679 - 687. [Abstract] [Full Text] [PDF]

				W. Plochl, C. G. Krenn, D. J. Cook, E. Gollob, T. Pezawas, H. Schima, O. Ipsiroglu, G. Wollenek, and G. Grubhofer Can hypocapnia reduce cerebral embolization during cardiopulmonary bypass? Ann. Thorac. Surg., September 1, 2001; 72(3): 845 - 849. [Abstract] [Full Text] [PDF]

				K. H. Rehfeldt and D. J. Cook Transesophageal Echocardiographic Imaging of a New Aortic Cannula for Differential Perfusion During Cardiopulmonary Bypass Anesth. Analg., February 1, 2001; 92(2): 338 - 340. [Abstract] [Full Text] [PDF]

				U. S. Boston, H. Sungurtekin, C. G.A. McGregor, J. A. Macoviak, and D. J. Cook Differential perfusion: a new technique for isolated brain cooling during cardiopulmonary bypass Ann. Thorac. Surg., May 1, 2000; 69(5): 1346 - 1350. [Abstract] [Full Text] [PDF]

				J. D. Puskas, A. D. Winston, C. E. Wright, J. P. Gott, W. M. Brown III, J. M. Craver, E. L. Jones, R. A. Guyton, and W. S. Weintraub Stroke after coronary artery operation: incidence, correlates, outcome, and cost Ann. Thorac. Surg., April 1, 2000; 69(4): 1053 - 1056. [Abstract] [Full Text] [PDF]

				T Wittwer, J Cremer, P Boonstra, J Grandjean, M Mariani, A Mugge, H Drexler, P den Heijer, E-R v Leitner, A Hepp, et al. Myocardial "hybrid" revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty: preliminary results of a multicentre study Heart, January 1, 2000; 83(1): 58 - 63. [Abstract] [Full Text] [PDF]

				T. Jones and R. C. Roy Should patients be normothermic in the immediate postoperative period? Ann. Thorac. Surg., October 1, 1999; 68(4): 1454 - 1455. [Full Text] [PDF]

				M. Gaudino, L. Martinelli, G. Di Lella, F. Glieca, P. Marano, R. Schiavello, and G. Possati SUPERIOR EXTENSION OF INTRAOPERATIVE BRAIN DAMAGE IN CASE OF NORMOTHERMIC SYSTEMIC PERFUSION DURING CORONARY ARTERY BYPASS OPERATIONS J. Thorac. Cardiovasc. Surg., September 1, 1999; 118(3): 432 - 437. [Abstract] [Full Text] [PDF]

				D. J. Cook Changing Temperature Management for Cardiopulmonary Bypass Anesth. Analg., June 1, 1999; 88(6): 1254 - 1254. [Full Text] [PDF]

				G. D. Trachiotis, W. S. Weintraub, T. S. Johnston, E. L. Jones, R. A. Guyton, and J. M. Craver Coronary artery bypass grafting in patients with advanced left ventricular dysfunction Ann. Thorac. Surg., November 1, 1998; 66(5): 1632 - 1639. [Abstract] [Full Text] [PDF]

				I. Birdi, I. Regragui, M. B. Izzat, A. J. Bryan, and G. D. Angelini INFLUENCE OF NORMOTHERMIC SYSTEMIC PERFUSION DURING CORONARY ARTERY BYPASS OPERATIONS: A RANDOMIZED PROSPECTIVE STUDY J. Thorac. Cardiovasc. Surg., September 1, 1997; 114(3): 475 - 481. [Abstract] [Full Text]

				R. S. D'Agostino, L. G. Svensson, D. J. Neumann, H. H. Balkhy, W. A. Williamson, and D. M. Shahian Screening Carotid Ultrasonography and Risk Factors for Stroke in Coronary Artery Surgery Patients Ann. Thorac. Surg., December 1, 1996; 62(6): 1714 - 1723. [Abstract] [Full Text]

				R. H. Habib, A. Zacharias, and M. Engoren Determinants of Prolonged Mechanical Ventilation After Coronary Artery Bypass Grafting Ann. Thorac. Surg., October 1, 1996; 62(4): 1164 - 1171. [Abstract] [Full Text]

				I. Regragui, I. Birdi, M. Bashar Izzat, A. M. S. Black, A. Lopatatzidis, C. J. E. Day, F. Gardner, A. J. Bryan, and G. D. Angelini THE EFFECTS OF CARDIOPULMONARY BYPASS TEMPERATURE ON NEUROPSYCHOLOGIC OUTCOME AFTER CORONARY ARTERY OPERATIONS: A PROSPECTIVE RANDOMIZED TRIAL J. Thorac. Cardiovasc. Surg., October 1, 1996; 112(4): 1036 - 1045. [Abstract] [Full Text]

				I. Birdi, M. B. Izzat, A. J. Bryan, and G. D. Angelini Normothermic Techniques During Open Heart Operations Ann. Thorac. Surg., May 1, 1996; 61(5): 1573 - 1580. [Abstract] [Full Text]

				T. A. Orszulak, D. J. Cook, R. C. Daly, and J. M. Craver Warm Heart Surgery and Stroke Ann. Thorac. Surg., January 1, 1996; 61(1): 276 - 277. [Full Text]