Normothermic versus hypothermic perfusion during primary coronary artery bypass grafting

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Abstract
Normothermic versus hypothermic cardiopulmonary bypass was evaluated in 1442 consecutive patients undergoing primary coronary artery bypass grafting (CABG). Group 1 (n = 545) were operated on in moderate systemic hypothermia (rectal temperature 28 °C) and group 2 (n = 897) in normothermia (rectal temperature 37 °C). Both groups had cold cardioplegic arrest (10 °C) and local cooling of the heart with slush. Anaesthesia and operative techniques were identical in both groups. The mean age was 60 years; group 2 contained significantly more patients aged >65 years (PPversus 76.6(26.0) min, Pversus 0.7%) Perioperative low cardiac output needing inotropic support was similar in both groups, but group 1 patients required more intra-aortic balloon insertions (4.6% versus 2.2%, PPPP<0.001). Normothermic cardiopulmonary bypass combined with cold cardioplegic arrest is safe and provides sufficient cardiac and total body protection during primary CABG. Several of the adverse effects of hypothermia can be avoided, such as prolonged cardiopulmonary bypass time and ventilatory support, disturbed haemostasis and transient renal failure.