Hypothermic ventricular fibrillation with pulsatile coronary perfusion during repair of ventricular septal perforation following infarction.

Emergency or urgent surgery for ventricular septal perforation (VSP) following acute myocardial infarction still carries a high operative mortality rate. Hypothermic fibrillatory arrest studies without aortic cross-clamping and using continuous pulsatile coronary flow were performed to improve this result. Of 19 patients suffering from VSP, 12 underwent hypothermic (mean(s.d.) blood temperature 23.5(1.7) degrees C) ventricular fibrillation with concomitant pulsatile systemic and continuous coronary perfusion (group 1), and seven underwent deep hypothermic cardioplegic ischaemic arrest with systemic pulsatile perfusion alone (group 2). The two groups were comparable in terms of age, sex, location of infarction, number of coronary arteries involved, interval between infarction and surgery, and preoperative maximum enzyme levels and haemodynamics. Pulsatile flow with a mean(s.d.) pulse pressure of 48(13) mmHg was produced by an intra-aortic balloon pumping device in both groups. Operative exposure in the two groups was comparable. In group 1, mean(s.d.) cardiac output in the early postoperative period (within 3 h of procedure) was significantly higher than in group 2 (4.2(0.9) versus 2.6(0.7)lmin-1m-2, P < 0.01). The 30-day operative mortality rate was significantly lower in group 1 (8% (80% confidence interval 1-29%)) than in group 2 (57% (80% confidence interval 28-83%)) (P < 0.05). On the basis of these results, hypothermic fibrillatory arrest with continuous pulsatile coronary perfusion can be recommended for myocardial protection during surgery for VSP associated with severe heart failure or cardiogenic shock.