Warm Heart Surgery for the Patient with Cold Agglutinins

Cold-reactive antibodies may cause complications such as hemolysis and myocardial damage due to their activity at low temperatures during cardiac surgery. The detection of cold agglutinins in a patient before the operation may change the operative strategy. This report describes a case with coronary artery disease in which the cold agglutinins with high-titer and high-thermal amplitude were detected preoperatively. The operation was conducted with normothermic cardiopulmonary bypass and warm blood cardioplegia. The management of this rare situation remains controversial but currently, warm heart surgery appears to be the most expedient method.