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Ak K, Dericioğlu O, Midi A, Kararmaz A, Er Z, Doğusan Z, Arsan S. Comparison of Bretschneider HTK and Blood Cardioplegia (4:1): A Prospective Randomized Study. Thorac Cardiovasc Surg 2024; 72:11-20. [PMID: 36638809 DOI: 10.1055/s-0042-1759710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND We compared the effect of intermittent blood and histidine-tryptophan-ketoglutarate (HTK) solution of Bretschneider on myocardial histopathology and perioperative outcome. METHODS Forty adult cardiac surgery patients were grouped into two (n = 20 for each): (1) Intermittent blood cardioplegia (IBC): had repeated cold 4:1 blood cardioplegia and (2) HTK: had a single dose of cold HTK for cardioprotection. Creatine kinase (CK)-MB, Troponin-I (cTn-I), pH, and lactate were studied in coronary sinus blood before and after aortic cross-clamping (AXC) and systemic blood at postoperative 6th, 24th, and 48th hours. Myocardial biopsy was performed before and after AXC for light microscopy. Vacuolation, inflammation, edema, and glycogen were graded semiquantitatively (from 0 to 3). The myocardial apoptotic index was evaluated via the terminal deoxynucleotidyl transferase dUTP nick end labeling. RESULTS There were no differences in perioperative clinical outcomes between the groups. The coronary sinus samples after AXC were more acidotic (7.15 ± 0.14 vs. 7.32 ± 0.07, p = 0.001) and revealed higher CK-MB (21.0 ± 12.81 vs. 12.60 ± 11.80, p = 0.008) in HTK compared with IBC. The HTK had significantly a higher amount of erythrocyte suspension intraoperatively compared with IBC (0.21 ± 0.53 vs. 1.68 ± 0.93 U, p = 0.001). Microscopically, myocardial edema was more pronounced in HTK compared with IBC after AXC (2.25 ± 0.91 vs. 1.50 ± 0.04, p = 0.013). While a significant increase in the apoptotic index was seen after AXC in both groups (p = 0.001), no difference was detected between the groups (p = 0.417). CONCLUSION IBC and HTK have a similar clinical outcome and protective effect, except for more pronounced myocardial edema and increased need for intraoperative transfusion with HTK.
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Affiliation(s)
- Koray Ak
- Department of Cardiovascular Surgery, Marmara University School of Medicine, Marmara Uninersitesi Hastanesi Mimar Sinan Cad. Fevzi Cakmak Mah. Ust Kaynarca Kalp ve Damar Cerrahisi Bolumu Pendik, Istanbul, Turkey
| | - Okan Dericioğlu
- Department of Cardiovascular Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Ahmet Midi
- Department of Pathology, Bahcesehir University, School of Medicine, Istanbul, Turkey
| | - Alper Kararmaz
- Department of Anesthesiology and Reanimation, Marmara University School of Medicine, Istanbul, Turkey
| | - Zafer Er
- Department of Cardiovascular Surgery, Bozok University Faculty of Medicine Ringgold Standard Institution, Yozgat, Yozgat, Turkey
| | - Zeynep Doğusan
- Department of Pathology, Bone Marrow Transplantation Unite, Yeni Yüzyıl University School of Medicine, Istanbul, Turkey
| | - Sinan Arsan
- Department of Cardiovascular Surgery, Marmara University School of Medicine, Istanbul, Turkey
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Dysfunction induced by ischemia versus edema: Does edema matter? J Thorac Cardiovasc Surg 2009; 138:141-7, 147.e1. [DOI: 10.1016/j.jtcvs.2008.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 11/13/2008] [Accepted: 12/14/2008] [Indexed: 11/18/2022]
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Collins MJ, Ozeki T, Zhuo J, Gu J, Gullapalli R, Pierson RN, Griffith BP, Fedak PWM, Poston RS. Use of diffusion tensor imaging to predict myocardial viability after warm global ischemia: possible avenue for use of non-beating donor hearts. J Heart Lung Transplant 2007; 26:376-83. [PMID: 17403480 DOI: 10.1016/j.healun.2006.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Revised: 11/10/2006] [Accepted: 12/12/2006] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The assessment of myocardial viability after global warm ischemia (WI) but before reperfusion is challenging. We hypothesized that fractional anisotropy (FA), a magnetic resonance imaging (MRI) parameter of water diffusion that characterizes cellular integrity within tissues, provides a rapid and useful method for evaluating the viability of hearts after WI. METHODS Dog hearts were exposed to 60 minutes of WI after exanguination, explanted and preserved in a cold, non-beating state for 6 hours, using continuous perfusion (CP) or static cold storage (CS). Toward the end of preservation, a global FA assessment, acquired using MRI, was compared with analyses obtained from myocardial biopsies that included adenosine triphosphate (ATP), endothelin-1 (ET-1) and caspase-3 levels, light microscopy and tetrazolium staining. Functional recovery was analyzed after restoration of blood flow on a non-working Langendorff preparation. RESULTS FA measured at the end of CP showed strong correlations with all parameters of functional recovery (developed pressure, R = 0.60; dP/dt, R = 0.96; -dP/dt, R = 0.96). Although FA also correlated with tissue levels of ATP, ET-1 and caspase-3 (R = 0.77, -0.84, -0.64), recovery of myocardial function did not correlate with these markers or any other conventional analyses of myocardial injury (troponin I, changes on light microscopy or tetrazolium staining). CONCLUSIONS FA, an MRI-based parameter that indicates cellular integrity, was found to reflect better myocardial ATP stores, less induction of ET-1 and caspase-3 and improved functional recovery of hearts after global WI. As a clinically applicable tool capable of rapidly differentiating reversible from lethal injury, diffusion tensor imaging may prove useful in the eventual adoption of non-beating donor hearts for transplantation.
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Affiliation(s)
- Michael J Collins
- Division of Cardiac Surgery, Department of Surgery, University of Maryland Medical System, Baltimore, Maryland 21201, USA
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Mizutani S, Al-Dadah AS, Bloch JB, Prasad SM, Diodato MD, Schuessler RB, Damiano RJ, Lawton JS. Hyperkalemic cardioplegia-induced myocyte swelling and contractile dysfunction: prevention by diazoxide. Ann Thorac Surg 2006; 81:154-9. [PMID: 16368355 DOI: 10.1016/j.athoracsur.2005.06.057] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Revised: 06/14/2005] [Accepted: 06/20/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hyperkalemic cardioplegia (9 degrees C) results in significant myocyte swelling and reduced contractility, representing a possible mechanism of myocardial stunning. Adenosine triphosphate-sensitive potassium channel (KATP) openers have been shown to ameliorate stunning. This study evaluated the hypothesis that a KATP opener would prevent hyperkalemic cardioplegia-induced myocyte swelling and reduced contractility. METHODS Isolated rabbit myocytes were perfused with 37 degrees C Tyrode's solution for 20 minutes, followed by test solution (9 degrees C or 37 degrees C) including control Tyrode's, Tyrode's + 100 micromol/L diazoxide (KATP opener), St. Thomas's solution; or 9 degrees C St. Thomas's + 100 micromol/L diazoxide or St. Thomas's + 100 micromol/L diazoxide + 20 micromol/L HMR1098 or 50 micromol/L 5-hydroxydeconoate (KATP blockers) for 20 minutes (n = 8 per group). Myocytes were then reexposed to 37 degrees C Tyrode's solution for 20 minutes. Volume and contractility were measured by videomicroscopy and video-based edge detection, respectively. RESULTS St. Thomas's solution (9 degrees C) caused significant myocyte swelling and associated reduced contractility (p < 0.05). The addition of diazoxide abolished myocyte swelling (p < 0.0001), and eliminated the associated reduced contractility (p < 0.05). Findings were unchanged by the addition of HMR 1098 and 5-hydroxydeconoate. CONCLUSIONS Diazoxide prevented myocyte swelling and reduced contractility secondary to hyperkalemic cardioplegia, and this was unchanged by the addition of either KATP channel blocker. Prevention of myocyte swelling was associated with improved contractility, consistent with the hypothesis that myocyte swelling may be a mechanism of myocardial stunning. Diazoxide may play a role in myocyte volume homeostasis by means of a mechanism separate from opening the KATP channel.
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Affiliation(s)
- Shinichi Mizutani
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110-1013, USA
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Prasad SM, Al-Dadah AS, Byrd GD, Flagg TP, Gomes J, Damiano RJ, Nichols CG, Lawton JS. Role of the sarcolemmal adenosine triphosphate-sensitive potassium channel in hyperkalemic cardioplegia-induced myocyte swelling and reduced contractility. Ann Thorac Surg 2006; 81:148-53. [PMID: 16368354 DOI: 10.1016/j.athoracsur.2005.06.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Revised: 06/14/2005] [Accepted: 06/20/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hyperkalemic cardioplegia (Plegisol) has been shown to result in myocyte swelling and reduced contractility. We have demonstrated the elimination of these detrimental effects by the addition of an adenosine triphosphate-sensitive K+ (KATP) channel opener. To examine whether the mitochondrial or sarcolemmal KATP channel might be involved, volume and contractility in isolated myocytes from wild-type mice and mice lacking the sarcolemmal KATP channel (Kir6.2-/-) were evaluated. METHODS Myocytes were perfused for 20 minutes each with control 37 degrees C Tyrode's solution, test solution, and then control solution. Test solutions were (n = 10 per group) either 9 degrees C Plegisol or 9 degrees C Plegisol with 100 micromol/L of diazoxide, a putative mitochondrial-specific KATP channel opener. Cell volume and contractility were measured by digital video microscopy at baseline and during the test solution and reexposure periods. RESULTS Myocytes from wild-type mice, perfused with 9 degrees C Plegisol, demonstrated significant cell swelling (11.2% +/- 0.4%; p < 0.01) and diminished contractility (32.5% +/- 9.6% reduction in percent shortening, 47.2% +/- 10.1% reduction in peak velocity of shortening, and 52.0% +/- 8.8% reduction in peak velocity of relengthening; p < 0.05) versus baseline. Cell swelling and diminished contractility were significantly reduced by the addition of diazoxide. In Kir6.2-/- myocytes, Plegisol caused a greatly reduced level of cell swelling (3.2% +/- 0.1%; p < 0.01), and this was unaffected by diazoxide. Contractility was unchanged in Kir6.2-/- myocytes after Plegisol. CONCLUSIONS The sarcolemmal KATP channel appears necessary for exaggerated cell swelling and reduced contractility to occur after hyperkalemic cardioplegia in mouse myocytes.
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Affiliation(s)
- Sandip M Prasad
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Hoenicke EM, Sun X, Strange RG, Damiano RJ. Donor heart preservation with a novel hyperpolarizing solution: superior protection compared with University of Wisconsin solution. J Thorac Cardiovasc Surg 2000; 120:746-54. [PMID: 11003758 DOI: 10.1067/mtc.2000.109705] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES A donor heart preservation solution was designed to use hyperpolarized arrest with the adenosine triphosphate-sensitive potassium-channel opener pinacidil. This solution contained concentrations of potassium, sodium, calcium, magnesium, lactobionate, and the buffer histidine specifically chosen to minimize intracellular calcium accumulation associated with prolonged ischemia. METHODS Twenty-four rabbit hearts were randomly assigned to receive 1 of 3 preservation solutions in a crystalloid-perfused Langendorff model: (1) prototype solution containing a 0.5 mmol/L concentration of pinacidil, (2) prototype solution without pinacidil as control, and (3) University of Wisconsin solution. Thirty minutes of initial perfusion preceded baseline data acquisition. Data comprised left ventricle pressure-volume curves generated by inflating an intraventricular latex balloon. After cardioplegic administration, hearts underwent 4 hours of hypothermic storage, followed by 60 minutes of reperfusion and postischemic data acquisition. RESULTS Postischemic developed pressure was better preserved by pinacidil solution (92.4% +/- 4.5%) than by the control (74.9% +/- 3.4%, P =.01) and University of Wisconsin solutions (66.7% +/- 5.1%, P =.001). Diastolic negative dP/dT was better preserved by pinacidil solution (104.4% +/- 10.2%) than by the control (80.2% +/- 4.2%, P =.034) and University of Wisconsin solutions (71.7% +/- 7.0%, P =.015). Diastolic compliance, expressed as baseline/postischemic diastolic slope ratios, was more poorly preserved by University of Wisconsin solution (0.67 +/- 0.07) than by the pinacidil (0.88 +/- 0.05, P =.041) and control solutions (0.87 +/- 0.05, P =.021). Postischemic coronary flow was higher in hearts exposed to pinacidil solution (77.8% +/- 3.0%) than in those exposed to the control (66.8% +/- 2.4%) and University of Wisconsin solutions (70.9% +/- 4.0%, P =.07). CONCLUSIONS The superiority of the pinacidil solution in this experiment demonstrated that hyperpolarized arrest with potassium-channel openers improves donor heart preservation when administered in a novel histidine-buffered lactobionate-enriched vehicle.
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Affiliation(s)
- E M Hoenicke
- Department of Surgery, Division of Cardiothoracic Surgery, The Milton S. Hershey Medical Center, Pennsylvania State University, Hershey, USA
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Stephenson ER, Jayawant AM, Baumgarten CM, Damiano RJ. Cardioplegia-induced cell swelling: prevention by normothermic infusion. Ann Thorac Surg 2000; 69:1393-8. [PMID: 10881811 DOI: 10.1016/s0003-4975(00)01227-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Previous work has shown significant swelling of isolated rabbit myocytes exposed to cold hyperkalemic cardioplegia; however, the effect of warm hyperkalemic cardioplegia on myocyte volume is unknown. This study examined the effect of warm hyperkalemic cardioplegia (St. Thomas' solution) on myocyte volume. METHODS Myocytes were enzymatically isolated and placed on an inverted video microscope. Tyrode's solution (37 degrees C) was infused for 10 minutes to establish baseline cell volumes. Subsequently, either the control Tyrode's or St. Thomas' was infused either at 37 degrees C and 9 degrees C respectively (n = 5 for all groups) for 20 minutes, followed by a 30-minute reperfusion with 37 degrees C Tyrode's. Cell volume was determined from cell images captured every 5 minutes. RESULTS Myocyte swelling occurred rapidly on exposure to cold St. Thomas' solution to a maximum of 9.8 +/- 2.1% (p < 0.001). In contrast, myocytes exposed to warm cardioplegia did not show any volume changes during exposure to cardioplegia. However, upon reexposure to Tyrode's, these cells showed shrinkage below their baseline volume (p < 0.001). CONCLUSIONS The cell swelling associated with hypothermic cardioplegia is prevented by normothermic infusion.
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Affiliation(s)
- E R Stephenson
- Section of Cardiothoracic and Vascular Surgery, The Milton S. Hershey Medical Center, Penn State Geisinger Health System, Hershey, Pennsylvania, USA
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Danetz JS, Davies RD, Clemo HF, Baumgarten CM. Rabbit ventricular myocyte volume changes as a direct result of crystalloid cardioplegia in congestive heart failure induced by aortic regurgitation. J Thorac Cardiovasc Surg 2000; 119:826-33. [PMID: 10733776 DOI: 10.1016/s0022-5223(00)70020-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We hypothesized that the cell volume of ventricular myocytes isolated from hearts in volume-overload congestive failure would respond differently to hypothermic cardioplegia than would sham-operated cohorts. METHODS Adult rabbits underwent either valvotomy and aortic regurgitation-induced heart failure or sham surgery. Congestive failure was confirmed clinically and by means of echocardiography. Cell volumes of isolated myocytes were measured by digital video microscopy. After equilibration in 37 degrees C physiologic solution, cells were suprafused with 9 degrees C standard or low-Cl(-) St Thomas' Hospital solution followed by reperfusion in 37 degrees C physiologic solution. RESULTS Exposure to cold St Thomas' Hospital solution for 20 minutes caused sham myocytes to swell by 8% (n = 9); cell volumes fully recovered on normothermic reperfusion. In contrast, congestive failure myocytes (n = 9) maintained their cell volume in cold St Thomas' Hospital solution and during reperfusion. Lowering the [K(+)][Cl(-)] product of St Thomas' Hospital solution by partially replacing Cl(-) with an impermeant anion prevented cellular edema in the sham group (n = 8) but caused a 4% swelling in failure myocytes (n = 10) on reperfusion. Osmotically shrinking the failure cells (n = 9) converted their behavior to that of sham cells. CONCLUSIONS In the absence of ischemia, congestive failure myocytes are less sensitive to cardioplegia-induced edema than sham cells. Low-Cl(-) cardioplegia, which prevents edema and protects the normal heart, induced swelling and may be detrimental in myopathic hearts. Differences in volume regulation in failure and sham myocytes may be due to activation of volume-sensitive channels that are turned off by osmotic shrinkage.
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Affiliation(s)
- J S Danetz
- Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA 23298-0551, USA
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Hoenicke EM, Peterseim DS, Ducko CT, Sun X, Damiano RJ. Donor heart preservation with the potassium channel opener pinacidil: comparison with University of Wisconsin and St. Thomas' solution. J Heart Lung Transplant 2000; 19:286-97. [PMID: 10713254 DOI: 10.1016/s1053-2498(99)00138-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hyperpolarized arrest with the potassium channel opener pinacidil has been shown to provide effective myocardial protection during short-term global ischemia. This study tested the hypothesis that pinacidil may provide effective long-term protection for heart transplant preservation. METHODS Four concentrations of pinacidil (50 microM, 100 microM, 0.5 mM, 1.0 mM) mixed in Krebs-Henseleit solution were compared with University of Wisconsin and St. Thomas' Hospital solutions in a Krebs-Henseleit perfused rabbit Langendorff model (n = 6 for each group). Hearts underwent 4 hours of hypothermic (4 degrees C) storage. Over a wide range of volumes, left ventricular systolic function, diastolic compliance, and coronary flow were measured prior to and following storage. Time to mechanical and electrical arrest, and post-ischemic percent tissue water were also measured. RESULTS Pinacidil 0.5 mM provided the best preservation of post-ischemic systolic function and coronary flow compared with the other pinacidil concentrations and was statistically equivalent to St. Thomas' solution in terms of post-ischemic systolic, diastolic, and flow properties. However, hearts protected with University of Wisconsin solution had significantly better preservation of systolic function and coronary flow. CONCLUSIONS This investigation demonstrated that pinacidil in Krebs-Henseleit solution possesses efficacy in long-term donor heart preservation. Pinacidil was equivalent to St. Thomas' solution but inferior to University of Wisconsin solution. Hyperpolarized arrest with potassium channel openers may be a novel strategy to improve donor heart preservation.
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Affiliation(s)
- E M Hoenicke
- Penn State Geisinger Health System, The Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA.
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Danetz JS, Clemo HF, Davies RD, Embrey RP, Damiano RJ, Baumgarten CM. Age-related effects of St Thomas' Hospital cardioplegic solution on isolated cardiomyocyte cell volume. J Thorac Cardiovasc Surg 1999; 118:467-76. [PMID: 10469961 DOI: 10.1016/s0022-5223(99)70184-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We tested the hypothesis that neonatal cells are more sensitive to cardioplegia-induced cell swelling than more mature cells and spontaneous swelling in the absence of ischemia can be prevented by cardioplegia with a physiologic KCl product. METHODS Cell volumes of isolated ventricular myocytes from neonatal (3-5 days), intermediate (10-13 days), and adult (>6 weeks) rabbits were measured by digital video microscopy. After equilibration in 37 degrees C physiologic solution, cells were suprafused with 37 degrees C or 9 degrees C St Thomas' Hospital solution (standard or low Cl(-)) or 9 degrees C physiologic solution followed by reperfusion with 37 degrees C physiologic solution. RESULTS Neonatal cells swelled 16.2% +/- 1.8% (P <.01) in 37 degrees C St Thomas' Hospital solution and recovered during reperfusion, whereas more mature cells maintained constant volume. In contrast, 9 degrees C St Thomas' Hospital solution caused significant age-dependent swelling (neonatal, 16.8% +/- 1.5%; intermediate, 8.6% +/- 2.1%; adult, 5.6% +/- 1.1%). In contrast to more mature cells, neonatal cells remained significantly edematous throughout reperfusion (8.1% +/- 1.5%). Swelling was not due to hypothermia because 9 degrees C physiologic solution did not affect volume. Lowering the KCl product of St Thomas' Hospital solution by partially replacing Cl(-) with an impermeant anion prevented cellular edema in all groups. CONCLUSION In the absence of ischemia, neonatal cells were more sensitive to cardioplegia-induced cellular edema than more mature cells, and edema observed in all groups was avoided by decreasing the KCl product of St Thomas' Hospital solution to the physiologic range. Differences in cell volume regulation may explain the sensitivity of neonatal hearts to hyperkalemic cardioplegic arrest and suggest novel approaches to improving myocardial protection.
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Affiliation(s)
- J S Danetz
- Department of Surgery (Division of Cardiothoracic Surgery), Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0551, USA
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Jayawant AM, Stephenson ER, Matte GS, Prophet GA, LaNoue KF, Griffith JW, Damiano RJ. Potassium-channel opener cardioplegia is superior to St. Thomas' solution in the intact animal. Ann Thorac Surg 1999; 68:67-74. [PMID: 10421117 DOI: 10.1016/s0003-4975(99)00446-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND In isolated hearts, the potassium-channel opener pinacidil is an effective cardioplegic agent. This study tested the hypothesis that pinacidil is superior to St. Thomas' solution in the more clinically relevant intact animal. METHODS Sixteen pigs were placed on full cardiopulmonary bypass. Hearts underwent 2 hours of global ischemia (10 degrees to 15 degrees C). Either St. Thomas' or 100 micromol/L pinacidil was administered every 20 minutes (10 mL/kg). Preischemic and postreperfusion slopes of the preload-recruitable stroke work relationship were determined. Changes in myocardial adenine nucleotide levels and cellular ultrastructure were analyzed. RESULTS Pinacidil cardioplegia resulted in an insignificant change in the slope of the preload-recruitable stroke work relationship (40.6+/-2.1 mm Hg/mm before ischemia and 36.5+/-3.7 mm Hg/mm after ischemia; p = 0.466). In contrast, St. Thomas' solution resulted in a significant decrease in the slope after reperfusion (34.3+/-5.5 mm Hg/mm and 13.5+/-2.3 mm Hg/mm; p = 0.003). Adenine nucleotide levels, myocardial tissue water, and ultrastructural changes were similar between groups. CONCLUSIONS Pinacidil ameliorated myocardial stunning associated with traditional hyperkalemic cardioplegia without causing significant differences in cellular metabolism.
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Affiliation(s)
- A M Jayawant
- Section of Cardiothoracic and Vascular Surgery, The Milton S. Hershey Medical Center, Pennsylvania State Geisinger Health System, Hershey 17033, USA
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