STROKE DURING CORONARY-ARTERY BYPASS-GRAFTING USING HYPOTHERMIC VERSUS NORMOTHERMIC PERFUSION

Does the abandonment of hypothermic perfusion during cardiopulmonary bypass compromise cerebral protection and thus lead to a higher incidence of stroke? From 1987 to June 1993, 2,585 consecutive patients underwent myocardial revascularization using warm-body (perfusion at 37 degrees C), cold-heart (cold cardioplegic arrest) surgical technique and were followed for new overt neurologic deficits. Perfusion pressure was maintained between 50 and 70 mm Hg, and hematocrit was kept around 20%. There were 25 operative deaths (1%) in this normothermic group, and new neurologic deficits developed after operation in 25 patients (1%). These results were compared retrospectively with those in 1,605 patients who underwent myocardial revascularization between 1980 and 1986 with moderate hypothermic (25 degrees to 30 degrees C) perfusion, the same surgical team, and similar operative techniques. The normothermic group included more elderly patients, more patients with left ventricular dysfunction and unstable angina, and more frequent use of an internal mammary artery conduit. Neurologic complication rates were 1% and 1.3% for the normothermic and hypothermic perfusion groups, respectively. Risk factors for stroke that were identified included age greater than 70 years, severity of aortic arch atherosclerosis, and severe hypotension in the perioperative period. Thus, in a large clinical series, the incidence of overt neurologic injuries was found to be no higher with normothermic perfusion than with hypothermic perfusion.