Continuous warm versus intermittent cold blood cardioplegia for coronary bypass surgery in patients with left ventricular dysfunction

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Abstract
Between October 1991 and March 1994, 108 consecutive patients withmoderate to severe left ventricular dysfunction underwent non-emergencyisolated coronary artery surgery under the care of one surgeon (A.R.). Theywere prospectively randomised to receiving either intermittent cold (Group1-50 patients) or continuous warm (Group 2-58 patients) blood cardioplegiafor myocardial protection. There were no significant differences inclinical outcome between the two groups, as judged by operative mortality,rates of perioperative myocardial infarction, the serum CKMB isoenzymelevel at 2 and 18 h after operation, need for circulatory support,postoperative neurological deficit, or duration of hospital stay. Group 2patients required significantly more potassium (68 vs 29 mmol, P <0.001) to maintain diastolic arrest and also had higher serum potassiumlevels after removal of the cross-clamp (P < 0.001). However, sinusrhythm returned spontaneously with greater frequency (91.2% vs 45.8%, P< 0.001) in Group 2 patients. In conclusion this report suggests thatretrograde continuous warm blood cardioplegia provides comparablemyocardial protection to that achieved with retrograde intermittent coldblood cardioplegia in patients with moderate to severe left ventriculardysfunction undergoing isolated coronary artery surgery.

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