CONTINUOUS WARM VERSUS INTERMITTENT COLD BLOOD CARDIOPLEGIA FOR CORONARY-BYPASS SURGERY IN PATIENTS WITH LEFT-VENTRICULAR DYSFUNCTION

Between October 1991 and March 1994, 108 consecutive patients with mod erate to severe left ventricular dysfunction underwent non-emergency i solated coronary artery surgery under the care of one surgeon (A.R.). They were prospectively randomised to receiving either intermittent co ld (Group 1-50 patients) or continuous warm (Group 2-58 patients) bloo d cardioplegia for myocardial protection, There were no significant di fferences in clinical outcome between the two groups, as judged by ope rative mortality, rates of perioperative myocardial infarction, the se rum CKMB isoenzyme level at 2 and 18 h after operation, need for circu latory support, postoperative neurological deficit, or duration of hos pital stay, Group 2 patients required significantly more potassium (68 vs 29 mmol, P<0.001) to maintain diastolic arrest and also had higher serum potassium levels after removal of the cross-clamp (P<0.001), Ho wever, sinus rhythm returned spontaneously with greater frequency (91. 2% vs 45.8%, P<0.001) in Group 2 patients, In conclusion this report s uggests that retrograde continuous warm blood cardioplegia provides co mparable myocardial protecton to that achieved with retrograde intermi ttent cold blood cardioplegia in patients with moderate to severe left ventricular dysfunction undergoing isolated coronary artery surgery.