Warm Heart Surgery
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* Vivek Rao
* Richard D. Weisel

**WARM HEART SURGERY.** Edited by Tomás Antonio Salerno. 230 pp. Illust. Arnold, London; Oxford University Press Canada, Toronto. 1996. $142.95. ISBN 0-340-61023-9

Despite apparently adequate blood cardioplegic protection, sensitive measures have suggested that the recovery of myocardial metabolism and ventricular function are delayed after elective cardiac surgery. Improved methods of myocardial protection are required for the increasing proportion of high-risk patients who undergo cardiac surgery. Hypothermia was first espoused by Bigelow in Toronto and has been a cornerstone for myocardial protection since the 1950s. Normothermic blood cardioplegia (“warm heart surgery”) was reintroduced in Toronto in 1989 and was associated with exciting early clinical results. These results spawned a plethora of basic science and clinical investigations into the effects of normothermic myocardial and systemic perfusion. The editor of this textbook, Dr. Tomás Salerno, was an early pioneer of this technique.

The 26 chapters in this book deal with the technical and conceptual aspects of warm heart surgery. The first three chapters provide a historical perspective on myocardial protection and discuss the theoretical framework leading to the reintroduction of normothermic cardioplegia. Chapter four is an in-depth review of nuclear magnetic resonance spectroscopy and its role in the investigation of alternative cardioplegic strategies. The next 12 chapters deal with the technical aspects of delivering warm blood cardioplegia either antegrade through the aortic root or retrograde through the coronary sinus. There is some redundancy in this part of the book because each chapter begins with a concise review of myocardial protection, which is already fully discussed in the first four chapters. However, each chapter provides a detailed description of the results of warm heart surgery in a wide variety of clinical situations, ranging from redo coronary bypass surgery to mitral valve surgery, congenital heart surgery and transplantation.

Eight chapters cover the extracardiac sequelae of warm heart surgery. The apparent myocardial benefit of normothermic perfusion prompted many investigators to employ normothermic systemic perfusion. There is a concern that systemic normothermia may result in a greater frequency of postoperative neurologic complications. A prospective randomized trial conducted at Emory University in Atlanta suggested that warm heart surgery was associated with myocardial benefit but normothermic systemic perfusion produced a neurologic threat. This trial was not discussed in this book in detail, leaving the reader with a slightly biased impression of the clinical results of normothermic perfusion.

The final chapter is a summary of the role of warm heart surgery in contemporary cardiac surgery. Written by Dr. Gerald Buckberg, a recognized authority on myocardial protection, this chapter provides a balanced argument for the selective use of normothermic cardioplegia, based on a variety of clinical scenarios.

The book is generally well written and easy to read. However, the text would have been enhanced by more illustrations. There is a suitable balance between the presentation of basic science research and the clinical implementation of normothermic cardioplegia. Therefore, this book will be of value to both clinicians and basic science investigators who have an interest in the results of warm heart surgery.