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Aass T, Stangeland L, Moen CA, Solholm A, Dahle GO, Chambers DJ, Urban M, Nesheim K, Haaverstad R, Matre K, Grong K. Left ventricular dysfunction after two hours of polarizing or depolarizing cardioplegic arrest in a porcine model. Perfusion 2018; 34:67-75. [PMID: 30058944 PMCID: PMC6304685 DOI: 10.1177/0267659118791357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This experimental study compares myocardial function after prolonged arrest by St. Thomas' Hospital polarizing cardioplegic solution (esmolol, adenosine, Mg2+) with depolarizing (hyperkalaemic) St. Thomas' Hospital No 2, both administered as cold oxygenated blood cardioplegia. METHODS Twenty anaesthetized pigs on tepid (34°C) cardiopulmonary bypass (CPB) were randomised to cardioplegic arrest for 120 min with antegrade, repeated, cold, oxygenated, polarizing (STH-POL) or depolarizing (STH-2) blood cardioplegia every 20 min. Cardiac function was evaluated at Baseline and 60, 150 and 240 min after weaning from CPB, using a pressure-conductance catheter and epicardial echocardiography. Regional tissue blood flow, cleaved caspase-3 activity and levels of malondialdehyde were evaluated in myocardial tissue samples. RESULTS Preload recruitable stroke work (PRSW) was increased after polarizing compared to depolarizing cardioplegia 150 min after declamping (73.0±3.2 vs. 64.3±2.4 mmHg, p=0.047). Myocardial tissue blood flow rate was high in both groups compared to the Baseline levels and decreased significantly in the STH-POL group only, from 60 min to 150 min after declamping (p<0.005). Blood flow was significantly reduced in the STH-POL compared to the STH-2 group 240 min after declamping (p<0.05). Left ventricular mechanical efficiency, the ratio between total pressure-volume area and blood flow rate, gradually decreased after STH-2 cardioplegia and was significantly reduced compared to STH-POL cardioplegia after 150 and 240 min (p<0.05 for both). CONCLUSION Myocardial protection for two hours of polarizing cardioplegic arrest with STH-POL in oxygenated blood is non-inferior compared to STH-2 blood cardioplegia. STH-POL cardioplegia alleviates the mismatch between myocardial function and perfusion after weaning from CPB.
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Affiliation(s)
- Terje Aass
- 1 Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,2 Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Lodve Stangeland
- 2 Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Christian Arvei Moen
- 1 Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Atle Solholm
- 1 Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Geir Olav Dahle
- 2 Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - David J Chambers
- 3 Cardiac Surgical Research, The Rayne Institute (King's College London), Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom
| | - Malte Urban
- 1 Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Knut Nesheim
- 1 Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- 1 Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,2 Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Knut Matre
- 2 Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ketil Grong
- 2 Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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