TEPID SYSTEMIC PERFUSION AND INTERMITTENT ISOTHERMAL BLOOD CARDIOPLEGIA IN CORONARY SURGERY

Background. To evaluate the safety and effectiveness of tepid perfusio n and isothermic blood cardioplegia in coronary surgery. Methods. We s tudied 200 patients undergoing myocardial revascularization: 100 proce dures were performed with moderate systemic hypothermia (28 degrees C) and cold crystalloid cardioplegia (4 degrees C); the other 100 patien ts received tepid systemic perfusion (TP) (34 degrees C) and intermitt ent blood cardioplegia at the same temperature according to the minica rdioplegia technique (Group 2). The two groups were comparable with re gards to age, extent of disease, preoperative left ventricular functio n and extra-corporeal circulation (ECC) time. Results. In the tepid gr oup we observed a higher incidence of spontaneous resumption of cardia c rhythm at cross-clamp removal compared to the hypothermic group (93% vs 34%; p<0.001). No difference was found in cardiac index at specifi ed intervals, myocardial enzymes, inotrope requirements, arrhythmias, need for vasopressors and postoperative blood loss. Fluid balance at t he end of ECC was significantly lower in the tepid group (343+/-635 mi vs 883+/-925 mi; p<0.001). Hospital mortality and morbidity were the same in the two groups. Conclusions. Our data suggest that TP and isot hermic blood cardioplegia represent a simple, safe and effective metho d of systemic and myocardial protection which may be an alternative to traditional hypothermia.