Results of Open Heart Surgery with Elective Cardiac Arrest by Potassium Citrate in Patients with Congenital and Acquired Heart Disease

¹ The Department of Cardiovascular Disease, The Cleveland Clinic Foundation and the Frank E. Bunts Institute.

Elective cardiac arrest, accomplished by perfusion of potassium citrate solution into the coronary circulation, has made possible excellent surgical exposure of intra-cardiac structures during open cardiotomy in 80 patients with a wide variety of congenital and acquired lesions. The cardioplegic effect of potassium was reversed by perfusing the coronary arteries with oxygenated blood. In no instance was death or surgical failure attributable to the use of cardiac arrest.

Forty-five patients have survived. Reasons for death have been stated within the limits of our present knowledge. The post-operative status of surviving patients has been evaluated on the basis of clinical findings and, when possible, by heart catheterization and cinecardioangiography six to 14 months after operation.

Anatomic correction with restoration of normal function may be anticipated in patients with atrial or ventricular septal defects, provided complete absence of the septum is not encountered.

Severe pulmonary hypertension is not a contra-indication to closure of septal defects, if there is a large left to right shunt with increased pulmonary flow.

In patients with Tetralogy of Fallot, inadequate closure of the ventricular septal defect has been found in most instances when a prosthesis has not been incorporated into the defect. These patients have shown clearcut evidence of functional improvement, with increased pulmonary blood flow and relief of arterial hypoxemia, but anatomic correction and restoration of normal cardiovascular dynamics has usually not been obtained.

Experience with this small group of patients emphasizes the need for further refinements in diagnosis, surgical technique, artificial perfusion and post-operative management before the ultimate potential of open heart surgery may be fully realized.