Warm body, cold heart surgery *1Clinical experience in 2817 patients

Abstract

Systemic hypothermia is used almost universally in cardiac surgery. Since 1987, 2817 patients have had normothermic cardiopulmonary bypass (NCPB, "warm body", bladder temperature 36 degrees C) with cold blood cardioplegic arrest ("cold heart", 8 degrees-14 degrees C) during open heart surgery. No patients were denied this technique regardless of age, condition or severity of surgery. Clinical Characteristics in Patients: Age range: 16-84 years, mean 66; male/female ratio 3:1; pump time (min) 24-183, mean 91; cross-clamp time (min) 15-148, mean 68; types of surgery: coronary artery bypass (n = 2214), valvular (n = 489) and miscellaneous (aneurysms, tumors, arrhythmias, congenital, etc) (n = 114). One thousand and sixty-nine (1069) patients had urgent coronary artery bypass grafting (CABG). The ejection fraction was less than 0.40 in 843 patients (30%). The thirty-day operative mortality for the entire group was 1.7% (48/2817 patients): CABG = 1% (23/2214 patients), valvular = 3% (15/489 patients) and miscellaneous 9% (10/114 patients). Postoperative complications were: perioperative myocardial infarction (34 patients) = 1.2%, postoperative bleeding requiring reexploration (37 patients) = 1.3%, stroke (27 patients) = 1%, and mediastinal infection (21 patients) = 0.7%. During NCPB (WARM) systemic vascular resistance was extremely low, cardiac output was high and it was easier to wean patients from the pump. No intraaortic balloon pump was used during this period. Pulmonary complications and coagulopathy were extremely rare. These results provide reassurance that NCPB (WARM) in combination with cold cardioplegic arrest provides excellent myocardial and total body protection during cardiac surgery and is particularly suitable for high-risk patients.

Effects of Perfusion Temperature on Inflammatory Response and Outcome Following Cardiopulmonary Bypass

“…Similar results have been reported by several authors (23,24). In a large observational study involving 2817 patients, Singh et al (23) found no evidence of important side effects due to normothermic CPB.…”

Effect of normothermic cardiopulmonary bypass on renal injury in pediatric cardiac surgery: A randomized controlled trial

“…5 The limited uncontrolled clinical data available suggest that the risks of renal failure associated with normothermic and hypothermic CPB are comparable. 6 Ip-Yam and associates 7 demonstrated no difference in creatinine clearance, fractional sodium excretion, microalbuminuria, and urinary N-acetyl-b-D-glucosaminidase (NAG) after normothermic (37 C) versus hypothermic (28 C) CPB. In a randomized controlled trial in adults, our group 8 demonstrated that CPB perfusion temperature does not influence perioperative changes in serum markers of renal function and that normothermic CPB was not associated with an increased risk of postoperative renal failure.…”

Strategy for Balancing Anticoagulation and Hemostasis in Aortocoronary Bypass Surgery

“…However, current evidence from the introduction of normothermic perfusion, shorter intubation time and improved hemodynamic conditions has been reported and, in addition, reduced blood loss is an another interesting piece of evidence. [13][14][15][16][17] The hemostatic effect of aprotinin in addition to the benefit of normothermic perfusion was the interesting subject of the present blood conservation trial.…”