Warm blood cardioplegia.
Between 1990 and 1992, 346 consecutive patients underwent coronary artery bypass procedures. Ninety-eight patients (group A) from 1990 served as historical controls, and 248 patients (group B) from 1991 to 1992 served as a prospective, consecutive cohort for statistical comparison. The two groups varied in the type of myocardial protection used: intermittent cold crystalloid cardioplegia was used in group A and continuous warm blood cardioplegia in group B. (Two patients in group A received intermittent cold blood cardioplegia, and these 2 patients are grouped with the crystalloid group for the sake of convenience. The presence or absence of these 2 patients did not alter the group A statistics in any noticeable manner). Class IV high-risk groups demonstrated a 63% reduction in mortality (p = 0.07), and overall group B experienced a 28% reduction in mortality (4.4% versus 6.1%; p = not significant), an 86% reduction in perioperative myocardial infarction rate (1.6% versus 12.2%; p < 0.05), a 20% reduction in postoperative bleeding (275 versus 345 mL.day-1.m-2), and a marked reduction in reentry rates (p = 0.05). Also noted was a 32% reduction in postoperative ventilation requirements (25 versus 37 hours; p = 0.05). Less inotrope was required and intraoperative stroke was not seen in the patients with warm blood cardioplegia. Group B patients were less likely to have development of complex postoperative arrhythmias. Ventricular fibrillation at unclamping was noticeably rare (2.0% in group B versus 84% in group A; p < 0.05). The average group B heart resumed sinus rhythm 72 seconds after declamping.(ABSTRACT TRUNCATED AT 250 WORDS)