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J Thorac Cardiovasc Surg 1996;112:175-184
© 1996 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

DEVELOPMENTAL DIFFERENCES IN CYTOSOLIC CALCIUM ACCUMULATION ASSOCIATED WITH SURGICALLY INDUCED GLOBAL ISCHEMIA: OPTIMIZATION OF CARDIOPLEGIC PROTECTION AND MECHANISM OF ACTION

Supported by the National Institutes of Health (HL 29077).

Received for publication March 27, 1995 Accepted for publication July 19, 1995. Address for reprints: Sidney Levitsky, MD, Division of Cardiothoracic Surgery, New England Deaconess Hospital, 110 Francis St., Suite 2C, Boston, MA 02215.

Abstract

Objective: The effect of cardioplegic solutions with high concentrations of potassium or magnesium (or both) on cytosolic calcium accumulation was investigated with fura-2 in isolated perfused mature (n = 24) and aged (n= 24) rabbit hearts. Methods: We compared cytosolic calcium accumulation before ischemia (control), during 30 minutes of ischemia and 30 minutes of reperfusion under global ischemia, or after treatment with potassium (20 mmol/L), magnesium (20 mmol/L), or both. Results: Cytosolic calcium accumulation was increased during global ischemia in the mature heart (from 178.7 ± 24.2 in the control group to 393.6 ± 25.5 nmol/L; p < 0.005) and in the aged heart (from 187.4 ± 18.7 in the control group to 501.0 ± 46.1 nmol/L; p < 0.005). Potassium reduced cytosolic calcium accumulation during ischemia in both the mature and aged hearts (300.9 ± 23.2 and 365.2 ± 27.7 nmol/L, respectively; p < 0.05 vs global ischemia). Magnesium and potassium/magnesium completely controlled cytosolic calcium accumulation in the mature heart (198.7 ± 27.5 nmol/L; p < 0.01 vs global ischemia and p < 0.05 vs potassium: 182.3 ± 22.7 nmol/L; p < 0.05 vs global ischemia and potassium, respectively). Magnesium and potassium/magnesium attenuated cytosolic calcium accumulation in the aged heart (261.3 ± 26.7, 262.3 ± 25.2 nmol/L, respectively; p < 0.01 vs global ischemia). These changes in cytosolic calcium accumulation correlated with improved postischemic ventricular function. To investigate the mechanism(s) of magnesium-supplemented cardioplegic inhibition of cytosolic calcium accumulation, we performed parallel studies (n = 43) using nifedipine, ryanodine, and dimethylthiourea. Nifedipine with or without ryanodine reduced cytosolic calcium accumulation. Dimethylthiourea did not alter cytosolic calcium accumulation during global ischemia. Our results suggest that cytosolic calcium accumulation during global ischemia was mainly increased via the sarcolemmal 1-type calcium channel and the sarcoplasmic reticulum calcium-release channel. The modulating action of potassium/magnesium cardioplegia on cytosolic calcium accumulation during ischemia would appear to act through the inhibition of the myocardial 1-type calcium channel and the sarcoplasmic reticulum calcium-release channel. Conclusion: Senescent cardiac dysfunction correlates with increased ischemia-induced cytosolic calcium accumulation. Magnesium-supplemented potassium cardioplegia ameliorates this age-related phenomenon at normothermia and may have important implications in myocardial protection in the elderly population. (J THORAC CARDIOVASC SURG 1996;112:175-84)

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