Warm heart surgery and results of operation for recent myocardial infarction

Samuel V. Lichtenstein, James G. Abel, Tomas A. Salerno

Research output: Contribution to journalArticle

46 Scopus citations

Abstract

Revascularization procedures after recent myocardial infarction are associated with higher mortality and morbidity compared with elective coronary artery bypass grafting. Traditional methods of myocardial protection impose a further ischemic insult on already compromised myocardium. Continuous cold blood cardioplegia may eliminate ischemia but may still leave the heart anaerobic. Theoretically, warm aerobic arrest addresses both of these issues and may become an attractive alternative to standard hypothermic ischemic arrest in this setting. In 115 nonrandomized patients undergoing coronary artery bypass grafting within 6 hours to 7 days of an acute myocardial infarction, myocardial protection was provided with continuous cold (4 °C) or continuous warm (37 °C) blood cardioplegia. Fifty-one patients (after 1988) protected with warm blood cardioplegia were compared with a historical cohort of 64 patients (before 1988) protected with cold blood cardioplegia. Results indicate that the warm cardioplegia group had no mortality versus 10.9% for the cold group (p < 0.05), a myocardial infarction rate of 2.0% in the warm versus 9.3% in the cold group, and use of intraaortic balloon pump of 0% versus 12.5%, respectively (p < 0.05). It is concluded that continuous warm aerobic arrest may minimize ischemia and anaerobic metabolism during the operative procedure, and may be of benefit to patients who have a limited tolerance to ischemic insult.

Original languageEnglish (US)
Pages (from-to)455-460
Number of pages6
JournalThe Annals of Thoracic Surgery
Volume52
Issue number3
DOIs
StatePublished - Sep 1991
Externally publishedYes

ASJC Scopus subject areas

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

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