The physiologic basis of warm cardioplegia

Michael C. Mauney, Irving L. Kron

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Background.: Advances in myocardial protection have been instrumental in making cardiac surgery safer. Debate exists over the optimal medium and the optimal temperature for cardioplegia. Currently blood cardioplegia is preferred over crystalloid; the optimal temperature, however, remains controversial. Methods.: Both warm and cold blood cardioplegia use potassium-induced electromechanical arrest, thereby reducing oxygen consumption by 90% in the working heart. Hypothermic blood cardioplegia given every 15 to 30 minutes provides a bloodless operative field and reduces oxygen consumption an additional 5% to 20%. Continuous warm cardioplegia avoids the deleterious effects of hypothermic ischemia and minimizes reperfusion injury. Perfusion is often interrupted for 5 to 10 minutes to allow adequate visualization of the operative site. Both warm and cold cardioplegia can be given either antegrade or retrograde. Results.: Retrospective studies from Toronto support the safety and efficacy of warm cardioplegia. Two large prospective, randomized trials of warm cardioplegia versus intermittent cold blood or cold crystalloid cardioplegia demonstrated equally low incidences of death, perioperative myocardial infarction, and need of intraaortic balloon pump support. Conclusions.: Warm blood cardioplegia represents the latest development in myocardial protection. Preliminary studies support its efficacy. Additional studies are needed to determine the ideal route of delivery and to identify any risks associated with the inherent warm cardiopulmonary bypass required.

Original languageEnglish (US)
Pages (from-to)819-823
Number of pages5
JournalThe Annals of Thoracic Surgery
Volume60
Issue number3
DOIs
StatePublished - Sep 1995
Externally publishedYes

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Induced Heart Arrest
Oxygen Consumption
Temperature
Reperfusion Injury
Cardiopulmonary Bypass
Thoracic Surgery
Potassium
Retrospective Studies
Perfusion
Myocardial Infarction
Safety

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

The physiologic basis of warm cardioplegia. / Mauney, Michael C.; Kron, Irving L.

In: The Annals of Thoracic Surgery, Vol. 60, No. 3, 09.1995, p. 819-823.

Research output: Contribution to journalArticle

Mauney, Michael C. ; Kron, Irving L. / The physiologic basis of warm cardioplegia. In: The Annals of Thoracic Surgery. 1995 ; Vol. 60, No. 3. pp. 819-823.
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