Predictable Spontaneous Beating in 96% of Coronary Bypass Operations

Abstract

To determine the incidence of spontaneous beating in isolated coronary bypass operations, one cardiac surgeon's experience with 677 consecutive cases over an 8 1/2 year period (1980-1988) was studied. Myocardial protection included hypothermic (4°C) blood cardioplegia containing procaine and papaverine, topical cooling (4°C) and systemic hypothermia (25°C). During warming, 100 mg of lidocaine was administered when body temperature reached 30°C. Six hundred fifty-one patients (96%) had spontaneous beating after removal of the aortic cross-clamp following completion of distal anastamoses. Electrical cardioversion was required immediately in 26 of these 677 patients (4%) and in an additional 32 (5%) later in the operation, usually when ventricular fibrillation was induced by manipulation of the beating heart to inspect the distal anastamoses. Therefore, 619 of these 677 coronary bypass patients (91 %) were spared intraoperative electrical cardioversion and its potential for myocardial damage.