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- Title
Left ventricular dysfunction after two hours of polarizing or depolarizing cardioplegic arrest in a porcine model.
- Authors
Moen, Christian Arvei; Solholm, Atle; Urban, Malte; Nesheim, Knut; Aass, Terje; Haaverstad, Rune; Stangeland, Lodve; Dahle, Geir Olav; Matre, Knut; Grong, Ketil; Chambers, David J.
- 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
- Subjects
HEART ventricle diseases; ADENOSINES; ANALYSIS of variance; ANIMAL experimentation; BLOOD gases analysis; CARDIOPULMONARY bypass; CATHETERIZATION; ECHOCARDIOGRAPHY; EXPERIMENTAL design; LEFT heart ventricle; HEART failure; HEART function tests; HEMODYNAMICS; POTASSIUM; RESEARCH funding; SWINE; OXIDATIVE stress; CARDIOPLEGIC solutions; DATA analysis software; TISSUE arrays; DESCRIPTIVE statistics; ESMOLOL
- Publication
Perfusion, 2019, Vol 34, Issue 1, p67
- ISSN
0267-6591
- Publication type
Article
- DOI
10.1177/0267659118791357