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J Thorac Cardiovasc Surg 1996;112:103-110
© 1996 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

PRESERVATION OF ENDOTHELIUM-DEPENDENT VASODILATION WITH LOW-POTASSIUM UNIVERSITY OF WISCONSIN SOLUTION

From the Division of Cardiothoracic Surgery, UCLA Medical Center, Los Angeles, Calif.

Received for publication July 3, 1995 Accepted for publication Sept. 5, 1995. Address for reprints: Davis C. Drinkwater, Jr., MD, Division of Cardiothoracic Surgery, Room B2-375 CHS, UCLA Medical Center, 10833 LeConte Ave., Los Angeles, CA 90095.

Abstract

University of Wisconsin solution has provided excellent myocardial preservation. However, the high potassium content of the currently available University of Wisconsin solution has been implicated in coronary artery endothelial damage. We placed 16 neonatal (age 1 to 3 days) Duroc piglet hearts on an isolated nonworking perfusion circuit. Endothelium-dependent and endothelium-independent vasodilation were tested by measuring coronary blood flow after intracoronary infusion of bradykinin (10^-6mol/L) and nitroprusside (10^–6mol/L), respectively. In addition, nitric oxide levels were measured after bradykinin infusion. The hearts were then arrested blindly with either a modified University of Wisconsin solution (group 1; n = 8, K⁺= 25 mEq/L) or standard University of Wisconsin solution (group 2; n = 8, K⁺= 129 mEq/L) by infusion of cardioplegic solution every 20 minutes for a total of 2 hours. After bradykinin infusion, the mean coronary blood flow increased by 237.1% ± 14.0% of baseline valves before arrest and by 232.8% ± 16.0% after arrest in group 1 (p = not significant). As in the first group, the mean coronary blood flow in group 2 increased by 231.1% ± 13.7% before arrest; however, the increase in mean coronary blood flow after arrest was significantly attenuated (163.3% ± 12.8%, p < 0.01). The loss of endothelium-dependent coronary blood flow response in group 2 correlated with a decreased capacity to release nitric oxide after arrest (prearrest 8.25 ± 2.30 nmol/min per gram versus postarrest –2.46 ± 2.29 nmol/min per gram, p < 0.01). Endothelium-independent vasodilatory response revealed no significant difference between groups before and after arrest. These results suggest that the low-potassium University of Wisconsin solution provides superior protection of the endothelium by preserving the endothelium-dependent vasodilatory response to nitric oxide release. (J THORAC CARDIOVASC SURG 1996;112:103-10)

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