A prospective randomised study of continuous warm versus intermittent cold blood cardioplegia for coronary artery surgery: preliminary report

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Abstract
Between October 1991 and March 1993, 281 consecutive patients underwentnon-emergency isolated coronary artery surgery under the care of onesurgeon (A.R.). They were prospectively randomised to receive eitherintermittent cold (Group I-144 patients) or continuous warm (Group II- 137patients) blood cardioplegia for myocardial protection. There were nosignificant differences in clinical outcome between the two groups, asjudged by operative mortality, rates of peri-operative myocardialinfarction, blood loss, need for circulatory support, post-operativeneurological deficit, or duration of intensive care or hospital stay.However, sinus rhythm returned spontaneously with greater frequency (91.2%vs 45.8%, P < 0.001) in Group II patients. There was greatertransmyocardial oxidative stress in Group I patients, as evidenced by asignificant rise in oxidised glutathione in coronary sinus blood onmyocardial reperfusion. Also, the serum CKMb isoenzyme level 2 h post-operatively was significantly raised in Group I patients, although thisdifference had disappeared by the day after surgery. In conclusion thispreliminary report suggests that continuous warm blood cardioplegiaprovides comparable myocardial protection to that achieved with standardhypothermic techniques in patients undergoing coronary artery surgery.

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