Warm heart surgery

S. V. Lichtenstein, K. A. Ashe, H. El Dalati, R. J. Cusimano, A. Panos, A. S. Slutsky

Research output: Contribution to journalArticle

307 Citations (Scopus)

Abstract

Hypothermia is widely acknowledged to be the fundamental component of myocardial protection during cardiac operations. Although it prolongs the period of ischemic arrest by reducing oxygen demands, hypothermia is associated with a number of major disadvantages, including its detrimental effects on enzymatic function, energy generation, and cellular integrity. We hypothesized that the ideal protected state of the heart would be electromechanically arrested and perfused with blood, that is, aerobic arrest. Under these conditions the fundamental need for hypothermia becomes questionable. We have developed a novel approach to myocardial protection during cardiac operations based on these concepts, in which the chemically arrested heart is perfused continuously with blood and maintained at 37° C. In 121 consecutive coronary bypass procedures we have compared this approach with a historical cohort of 133 consecutive patients treated with hypothermic cardioplegia. Perioperative myocardial infarction was significantly less prevalent (1.7% versus 6.8%; p < 0.05) in the warm cardioplegic group, as was the use of the intraaortic balloon pump (0.9% versus 9.0%; p < 0.005) and the prevalence of low output syndrome (13.5% versus 3.3%; p < 0.005). Cardiac output immediately after bypass was significantly higher than before bypass (3.1 ± 0.9 versus 4.9 ± 1.0 L/min; p < 0.001) only in the warm cardioplegia group. Furthermore, the heartbeat in 99.2% of patients treated with continuous warm cardioplegia converted to normal sinus rhythm spontaneously after removal of the aortic crossclamp compared with only 10.5% of the hypothermic group. The time from removal of the aortic crossclamp to discontinuation of cardiopulmonary bypass (i.e., reperfusion time) was significantly shorter in the warm cardioplegia group (11 ± 4.3 versus 27 ± 5.6 minutes; p < 0.001). Our results suggest that continuous normothermic blood cardioplegia is safe and effective. Conceptually, this represents a new approach to the problem of maintaining excellent myocardial preservation during cardiac operations.

Original languageEnglish
Pages (from-to)269-274
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume101
Issue number2
StatePublished - Jan 1 1991
Externally publishedYes

Fingerprint

Induced Heart Arrest
Thoracic Surgery
Hypothermia
Cardiopulmonary Bypass
Cardiac Output
Reperfusion
Myocardial Infarction
Oxygen

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Lichtenstein, S. V., Ashe, K. A., El Dalati, H., Cusimano, R. J., Panos, A., & Slutsky, A. S. (1991). Warm heart surgery. Journal of Thoracic and Cardiovascular Surgery, 101(2), 269-274.

Warm heart surgery. / Lichtenstein, S. V.; Ashe, K. A.; El Dalati, H.; Cusimano, R. J.; Panos, A.; Slutsky, A. S.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 101, No. 2, 01.01.1991, p. 269-274.

Research output: Contribution to journalArticle

Lichtenstein, SV, Ashe, KA, El Dalati, H, Cusimano, RJ, Panos, A & Slutsky, AS 1991, 'Warm heart surgery', Journal of Thoracic and Cardiovascular Surgery, vol. 101, no. 2, pp. 269-274.
Lichtenstein SV, Ashe KA, El Dalati H, Cusimano RJ, Panos A, Slutsky AS. Warm heart surgery. Journal of Thoracic and Cardiovascular Surgery. 1991 Jan 1;101(2):269-274.
Lichtenstein, S. V. ; Ashe, K. A. ; El Dalati, H. ; Cusimano, R. J. ; Panos, A. ; Slutsky, A. S. / Warm heart surgery. In: Journal of Thoracic and Cardiovascular Surgery. 1991 ; Vol. 101, No. 2. pp. 269-274.
@article{96cb7e53706e49a189e74044d86064c2,
title = "Warm heart surgery",
abstract = "Hypothermia is widely acknowledged to be the fundamental component of myocardial protection during cardiac operations. Although it prolongs the period of ischemic arrest by reducing oxygen demands, hypothermia is associated with a number of major disadvantages, including its detrimental effects on enzymatic function, energy generation, and cellular integrity. We hypothesized that the ideal protected state of the heart would be electromechanically arrested and perfused with blood, that is, aerobic arrest. Under these conditions the fundamental need for hypothermia becomes questionable. We have developed a novel approach to myocardial protection during cardiac operations based on these concepts, in which the chemically arrested heart is perfused continuously with blood and maintained at 37° C. In 121 consecutive coronary bypass procedures we have compared this approach with a historical cohort of 133 consecutive patients treated with hypothermic cardioplegia. Perioperative myocardial infarction was significantly less prevalent (1.7{\%} versus 6.8{\%}; p < 0.05) in the warm cardioplegic group, as was the use of the intraaortic balloon pump (0.9{\%} versus 9.0{\%}; p < 0.005) and the prevalence of low output syndrome (13.5{\%} versus 3.3{\%}; p < 0.005). Cardiac output immediately after bypass was significantly higher than before bypass (3.1 ± 0.9 versus 4.9 ± 1.0 L/min; p < 0.001) only in the warm cardioplegia group. Furthermore, the heartbeat in 99.2{\%} of patients treated with continuous warm cardioplegia converted to normal sinus rhythm spontaneously after removal of the aortic crossclamp compared with only 10.5{\%} of the hypothermic group. The time from removal of the aortic crossclamp to discontinuation of cardiopulmonary bypass (i.e., reperfusion time) was significantly shorter in the warm cardioplegia group (11 ± 4.3 versus 27 ± 5.6 minutes; p < 0.001). Our results suggest that continuous normothermic blood cardioplegia is safe and effective. Conceptually, this represents a new approach to the problem of maintaining excellent myocardial preservation during cardiac operations.",
author = "Lichtenstein, {S. V.} and Ashe, {K. A.} and {El Dalati}, H. and Cusimano, {R. J.} and A. Panos and Slutsky, {A. S.}",
year = "1991",
month = "1",
day = "1",
language = "English",
volume = "101",
pages = "269--274",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Warm heart surgery

AU - Lichtenstein, S. V.

AU - Ashe, K. A.

AU - El Dalati, H.

AU - Cusimano, R. J.

AU - Panos, A.

AU - Slutsky, A. S.

PY - 1991/1/1

Y1 - 1991/1/1

N2 - Hypothermia is widely acknowledged to be the fundamental component of myocardial protection during cardiac operations. Although it prolongs the period of ischemic arrest by reducing oxygen demands, hypothermia is associated with a number of major disadvantages, including its detrimental effects on enzymatic function, energy generation, and cellular integrity. We hypothesized that the ideal protected state of the heart would be electromechanically arrested and perfused with blood, that is, aerobic arrest. Under these conditions the fundamental need for hypothermia becomes questionable. We have developed a novel approach to myocardial protection during cardiac operations based on these concepts, in which the chemically arrested heart is perfused continuously with blood and maintained at 37° C. In 121 consecutive coronary bypass procedures we have compared this approach with a historical cohort of 133 consecutive patients treated with hypothermic cardioplegia. Perioperative myocardial infarction was significantly less prevalent (1.7% versus 6.8%; p < 0.05) in the warm cardioplegic group, as was the use of the intraaortic balloon pump (0.9% versus 9.0%; p < 0.005) and the prevalence of low output syndrome (13.5% versus 3.3%; p < 0.005). Cardiac output immediately after bypass was significantly higher than before bypass (3.1 ± 0.9 versus 4.9 ± 1.0 L/min; p < 0.001) only in the warm cardioplegia group. Furthermore, the heartbeat in 99.2% of patients treated with continuous warm cardioplegia converted to normal sinus rhythm spontaneously after removal of the aortic crossclamp compared with only 10.5% of the hypothermic group. The time from removal of the aortic crossclamp to discontinuation of cardiopulmonary bypass (i.e., reperfusion time) was significantly shorter in the warm cardioplegia group (11 ± 4.3 versus 27 ± 5.6 minutes; p < 0.001). Our results suggest that continuous normothermic blood cardioplegia is safe and effective. Conceptually, this represents a new approach to the problem of maintaining excellent myocardial preservation during cardiac operations.

AB - Hypothermia is widely acknowledged to be the fundamental component of myocardial protection during cardiac operations. Although it prolongs the period of ischemic arrest by reducing oxygen demands, hypothermia is associated with a number of major disadvantages, including its detrimental effects on enzymatic function, energy generation, and cellular integrity. We hypothesized that the ideal protected state of the heart would be electromechanically arrested and perfused with blood, that is, aerobic arrest. Under these conditions the fundamental need for hypothermia becomes questionable. We have developed a novel approach to myocardial protection during cardiac operations based on these concepts, in which the chemically arrested heart is perfused continuously with blood and maintained at 37° C. In 121 consecutive coronary bypass procedures we have compared this approach with a historical cohort of 133 consecutive patients treated with hypothermic cardioplegia. Perioperative myocardial infarction was significantly less prevalent (1.7% versus 6.8%; p < 0.05) in the warm cardioplegic group, as was the use of the intraaortic balloon pump (0.9% versus 9.0%; p < 0.005) and the prevalence of low output syndrome (13.5% versus 3.3%; p < 0.005). Cardiac output immediately after bypass was significantly higher than before bypass (3.1 ± 0.9 versus 4.9 ± 1.0 L/min; p < 0.001) only in the warm cardioplegia group. Furthermore, the heartbeat in 99.2% of patients treated with continuous warm cardioplegia converted to normal sinus rhythm spontaneously after removal of the aortic crossclamp compared with only 10.5% of the hypothermic group. The time from removal of the aortic crossclamp to discontinuation of cardiopulmonary bypass (i.e., reperfusion time) was significantly shorter in the warm cardioplegia group (11 ± 4.3 versus 27 ± 5.6 minutes; p < 0.001). Our results suggest that continuous normothermic blood cardioplegia is safe and effective. Conceptually, this represents a new approach to the problem of maintaining excellent myocardial preservation during cardiac operations.

UR - http://www.scopus.com/inward/record.url?scp=0025753993&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025753993&partnerID=8YFLogxK

M3 - Article

VL - 101

SP - 269

EP - 274

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 2

ER -