Topical cardiac hypothermia in patients with coronary disease: An unnecessary adjunct to cardioplegic protection and cause of pulmonary morbidity

B. S. Allen, G. D. Buckberg, E. R. Rosenkranz, W. Plested, J. Skow, E. Mazzei, R. Scanlan

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

This retrospective analysis tests the hypothesis that topical cardiac hypothermia is an unnecessary adjunct to intraoperative myocardial protection and an avoidable cause of pulmonary morbidity in patients with coronary disease receiving blood cardioplegia. The hospital records of 150 nonrandomized consecutive patients undergoing elective and emergency isolated coronary revascularization were reviewed. All patients received multidose cold blood cardioplegia followed by warm blood cardioplegic reperfusion distributed through grafts. Fifty patients received iced slush, 50 received topical 4° C saline, and no topical cooling was used in 50 others. Patient groups were comparable in number of grafts (3.7 versus 3.5 versus 3.5) and crossclamp time (61 versus 62 versus 61 minutes). More emergency operations were performed in the patients receiving no topical hypothermia (12/50 versus 8/50 versus 7/50). Postoperative x-ray films were reviewed by a radiologist who did not know of patient grouping. Postoperative results were comparable in hemodynamics, inotropic requirements (10/50 ice versus 8/50 saline versus 5/50 no cooling), myocardial infarction (1/50 versus 2/50 versus 2/50), and enzymes (aspartate aminotransferase myocardial band creatine kinase). No patient died. Ice topical hypothermia (versus no topical cooling) was associated with more left pleural effusions (25/50 versus 9/50; p < 0.05), atelectasis (33/50 versus 18/50; p < 0.05), elevated left hemidiaphragms (13/50 versus 0/50; p < 0.05), and longer postoperative hospitalization (11.2 versus 8.5 days; p < 0.05). Topical 4° C saline reduced diaphragmatic elevation and pleural effusion (versus topical ice) but was associated with more atelectasis (34/50 versus 18/50; p < 0.05) than no topical cooling. These data suggest that routine topical hypothermia is an unnecessary adjunct to blood cardioplegic protection in patients with coronary disease, since supplemental topical cooling does not improve postoperative hemodynamics or reduce inotropic requirements, enzyme release, or prevalence of postoperative myocardial infarction, and it increases pulmonary morbidity, which can be reduced by its avoidance.

Original languageEnglish (US)
Pages (from-to)626-631
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume104
Issue number3
DOIs
StatePublished - Jan 1 1992

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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