WHAT IS THE BEST PERFUSION TEMPERATURE FOR CORONARY REVASCULARIZATION

Background: A National Institutes of Health-funded clinical trial of p atients undergoing coronary artery bypass randomized perfusate and myo cardial preservation to cold, tepid, or warm temperatures, The goal of the trial was to evaluate neurologic function before and after operat ion (4 days and 1 month after operation) and to measure hematologic da ta for fibrinolytic potential, Methods: The three groups comprised 116 patients who completed neurologic evaluation by means of the Mathew s cale out of 130 entered into the trial (37 cold group, 50 tepid, and 4 3 warm), Twenty-five patients had complete hematologic studies done, A ll three groups were comparable before operation, The myocardial prese rvation protocol used blood cardioplegic solution at cold (8 degrees t o 10 degrees C), tepid (32 degrees C), or warm (37 degrees C) temperat ure and the systemic perfusate temperature during cardiopulmonary bypa ss was 20 degrees (cold), 32 degrees C (tepid), or 37 degrees C (warm) . Results: Patients in the cold group had a longer duration of intubat ion and postoperative hospitalization and a slightly but significantly higher peak postoperative creatine kinase MB level than patients in t he warm group, There were no deaths, There was deterioration in Mathew scale findings in all three groups, and no distinction could be made between groups, However, a significantly higher number in the cold gro up had an abnormal postoperative neurologic examination result that pr ompted computed tomographic scanning (18.9% cold, 2% tepid, 9.3% warm) , A cerebrovascular accident was documented by computed tomographic sc anning in 8.1%, 0%, and 4.7% of patients in the cold, tepid, and warm groups, respectively (not significant), Hematologic data documented si gnificantly increased fibrinolytic potential in the warm group, Conclu sions: Perfusion temperature is a factor in recovery from cardiopulmon ary bypass, Cold has more adverse neurologic sequelae that prompt comp uted tomographic scanning whereas warm has more activation of fibrinol ytic potential, Tepid is the best temperature for optimizing recovery from cardiopulmonary bypass.