The temperature dependence of recovery of metabolic function following hypothermic potassium cardioplegic arrest

The effects of a temperature below 15 degrees C on the myocardial calcium and ultrastructure in donor heart preservation in a canine model

The effects of 6-h hypothermic cardioplegic arrest on myocardial biochemical, morphologic, and functional recovery were investigated in two groups of dogs. Group 1 (n = 6) was subjected to hypothermia of 15 degrees C and group 2 (n = 6) was subjected hypothermia of 5 degrees C. Although the myocardial calcium (Ca) concentration was significantly higher at the end of reperfusion in group 2 compared to group 1, the MB-fraction of creatine kinase, mitochondrial aspartate aminotransferase, recovery of left ventricular systolic function, and mitochondrial morphologic integrity were better in group 2 than in group 1. These findings suggest that hypothermia of 5 degrees C in 6-h cardioplegia is not necessarily coupled with interference in myocardial contractility, despite the Ca overload that occurs during reperfusion.

Facilitating effect of cold shock on recovery from anoxia-induced contractile depression in isolated rat heart and heart muscle

The effect of rapid cooling on the recovery process from anoxia-induced hypodynamic state was studied in isolated rat ventricular muscle and ventricle. Following 10-15 minutes' perfusion of N2-saturated Krebs solution, the muscle was reoxygenated. When the muscle was rapidly cooled for 10-30 seconds during the early phase of reoxygenation, the rate of recovery from contracture significantly increased (p less than 0.01). Rapid cooling was also effective on the recovery from contracture induced by superfusion of Krebs solution with lowered sodium chloride concentration, but it did not affect the recovery from rigor induced by CN-. In the recovery from sustained anoxia (60 minutes), cooling facilitated reattainment of tension development and reduction in contracture tension. Similarly, in whole heart, 2-3 episodes of rapid cooling for about 60 seconds significantly accelerated the recovery of pressure development after 30 minutes of anoxia. At 60 minutes after reoxygenation, pressure development in hearts that were reoxygenated without rapid cooling was 29.8 +/- 26.9% (mean +/- SD) of pressure developed before anoxia. This value increased to 93.8 +/- 27.5% following recurrent rapid cooling (p less than 0.001). At the same time, rapid cooling prevented any significant elevation in resting tension (development of oxygen paradox). These results indicate that excess intracellular calcium ions were removed by rapid cooling. This relief of the myocardium from calcium overload is believed to improve mitochondrial function and result in facilitated recovery of contractile activity.

Pathophysiology of superoxide radical as potential mediator of reperfusion injury in pig heart

The role of oxygen-derived free radicals in myocardial reperfusion injury was studied using the isolated in situ pig heart model. The free radical scavengers, superoxide dismutase (SOD) and catalase, protected the ischemic pig heart subjected to one hour of normothermic regional ischemia followed by one hour of global hypothermic arrest and one hour normothermic reperfusion. A significant increase in thiobarbituric acid reactive material and oxidized glutathione appeared in the perfusate demonstrating free radical-mediated lipid peroxidation during reperfusion, and this was prevented by the addition of SOD plus catalase. The values of three important antioxidative enzymes, SOD, catalase, and glutathione peroxidase, showed reduced activities after 2 hours of ischemia. These values did not change significantly after 60 minutes of reperfusion following the 2 hours ischemic insult. The concentrations of high-energy phosphate compounds including creatine phosphate (CP), adenosine triphosphate (ATP), and total adenine nucleotide were reduced significantly during ischemia and reperfusion in hearts which were not protected by SOD and catalase. The plasma creatine phosphokinase levels were lowered appreciably as a result of SOD and catalase treatment. It may be concluded from these experiments that oxygen-derived free radicals are present during reperfusion and SOD and catalase play a significant role in the protection of ischemic myocardium from reperfusion injury.

Recent advances in cardiopulmonary bypass and the clinical application of myocardial protection

Basic scientific research has provided the impetus to develop cardioplegic solutions that offer excellent myocardial preservation. Future research will continue to develop methods for better delivery of cardioplegia to all myocardial regions. In addition, earlier detection of evolving ischemic damage during aortic cross-clamping might provide a basis for earlier intervention to reverse developing myocardial injury. At the present time, the cardiac surgeon has many cardioplegic solutions and delivery systems from which to choose. Only by understanding the principles involved in myocardial preservation will the surgeon be able to develop a system that will work best in his or her clinical practice.

Concepts and techniques of myocardial protection for adult open heart surgery

Discussions of myocardial protection are often limited to the subject of cardioplegia. However, numerous aspects of operative and perioperative care are of comparable importance. This article outlines the broad topic of myocardial protection, provides strategies for its practical implementation, and reports the author's personal results.