WARM BLOOD CARDIOPLEGIA IN HIGH-RISK PATIENTS

Objective: Despite overall good clinical results, cardiac surgery in h igh risk patients, such as those with poor left ventricular function o r heavily hypertrophied myocardium, is still challenging. This study w as designed to assess the efficacy of warm blood cardioplegia (WBC) in these two subgroups of patients. Methods: Fifty-two patients, with an ejection fraction less than 50%, who underwent surgical revasculariza tion, and 36 patients, with marked left ventricular hypertrophy (LVH), who were operated on for aortic valve replacement (AVR), were consecu tively studied. All of them received continuous retrograde 'warm' bloo d cardioplegia. Results were assessed on clinical outcomes and compare d with those predicted from a risk-stratifying index which has been pr eviously validated in a large multicenter population-based study (Onta rio score). Results: For cardiac revascularization, the rates of overa ll hospital mortality. Q-wave infarctions and inotropic use were respe ctively 5.8%, 9.6% and 21.1%, comparing favorably with those of the On tario Group. For aortic valve replacement, the incidence of hospital m ortality and Q-wave infarction was 2.8%. Conclusions: By virtue of the study design, these data cannot conclusively establish the superiorit y of warm blood cardioplegia over other methods of myocardial protecti on. However, they support the safety of this technique, and suggest th at these subgroups of high risk patients might represent the elective indication for aerobic arrest. (C) 1997 Elsevier Science B.V.