Benefits of Terminal Noncardioplegic Warm Blood Retrograde Perfusion After Terminal Warm Blood Cardioplegia Perfusion Prior to Aortic Unclamping in Open Heart Surgery

Background: The benefits of terminal noncardioplegic warm blood retrograde perfusion (TNWB) and terminal warm blood cardioplegia perfusion (TWBC) after intermittent cold blood cardioplegia perfusion during aortic clamping were studied.

Methods: The clinical results of consecutive 128 patients who underwent on pump coronary artery bypass grafting (CABG) or valvular surgery were studied retrospectively. The aortic cross-clamp was removed (1) after five-minute TWBC and sequential three-minute TNWB in 59 patients (TNWB group), (2) immediately after five-minute TWBC in 29 patients (TWBC group), or (3) with neither TWBC or TNWB in 36 patients (control group).

Results: The incidence of spontaneous heart beat recovery was best in TNWB group, second in TNBC, and worst in control group (TNWB: 86, TWBC: 42, Control: 14%). The duration from aortic unclamping to heart beat recovery was shorter in TNWB group than TWBC group (TNWB: 2.1, TWB: 4.3 min). Cardiopulmonary bypass duration after aortic unclamping was shortest in TNWB group, second in TWBC group, and longest in control group (TNWB: 21.3, TWB: 27.5, Control: 46.9 min). The postoperative CPK-MB was lowest in TNWB group (TNWB: 65.3, TWB: 87.7, Control: 91.9U/L). Duration of intubation in TNWB group or TWBC group was shorter than control.

Conclusions: Combination of the terminal noncardioplegic warm blood perfusion and terminal warm blood cardioplegic perfusion contributes to increase the incidence of spontaneous heart beat recovery, shortens cardiopulmonary bypass duration following aortic unclamping, and lowers postoperative CPK-MB.