Prolonged safe ischemic cardiac arrest using hypothermic Bretschneider cardioplegia combined with topical cardiac cooling. Clinical experience with cardiac arrest of up to 180 minutes in a few borderline cases.

Out of 494 patients operated upon using Bretschneider cardioplegia, 8 complicated surgical procedures (3 cases of single or double valve replacement combined with coronary bypass grafting, 2 cases of double valve replacement, 2 cases of multiple coronary bypass procedures and one case of aortic valve replacement with replacement of the ascending aorta) required a mean aortic cross-clamp time of 164 minutes. Four patients had a single infusion, and 4 other patients 2 or more infusions, of cold cardioplegic solution. With the aid of topical cooling, the myocardial temperature was reduced to a mean value of 12.8 degrees C. Postoperatively the heart in all patients resumed a good contractile activity. None sustained myocardial infarction during the perioperative or postoperative period. One patient died on the 19 postoperative day because of subdural hemorrhage not related to the cardioplegic procedure. All other patients have survived from 10 to 63 months (mean 23 months).