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J Thorac Cardiovasc Surg 1997;113:567-575
© 1997 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

MYOCARDIAL PROTECTION IN THE ACUTELY INJURED HEART: HYPERPOLARIZING VERSUS DEPOLARIZING HYPOTHERMIC CARDIOPLEGIA

Supported by a National Institutes of Health National Research Service Award, grant HL09125-02 (J. S. L., R. J. D.) and National Institutes of Health grant RO1 HL51032 (R. J. D.).

Received for publication June 19, 1996. revisions requested August 22, 1996; revisions received Sept. 9, 1996 accepted for publication Sept. 23, 1996. Address for reprints: Ralph J. Damiano, Jr., MD, Hershey Medical Center, Pennsylvania State University, P.O. Box 850, Hershey, PA 17033.

Abstract

Objectives: The superiority of hyperpolarized arrest with adenosine triphosphate–sensitive potassium channel openers over standard hyperkalemic depolarizing cardioplegia during normothermic ischemia has been documented. This study examined the hypothesis that pinacidil would provide superior protection in a more clinically relevant model of an acutely injured heart and hypothermic cardioplegic arrest.

Methods: In a blood-perfused, parabiotic, rabbit heart Langendorff model, hearts underwent 15 minutes of unprotected global normothermic ischemia before the administration of 50 ml of cardioplegic solution at 4° C, followed by 50 minutes of hypothermic (15° C) ischemia and 30 minutes of reperfusion. The cardioplegic solutions administered consisted of Krebs-Henseleit solution alone (N = 6), Krebs-Henseleit solution with pinacidil (50 µmol/L; N = 10), Krebs-Henseleit solution with pinacidil (50 µmol/L) and glibenclamide (a potassium channel blocker, 10 µmol/L; N = 8), or St. Thomas' Hospital solution (N = 8). The percent recovery of developed pressure, linear diastolic pressure-volume relationships, and coronary blood flow were compared.

Results: The percent recovery of developed pressure was 32.8% ± 2.8%, 43.0% ± 4.3%, 46.5% ± 2.2%, and 49.3% ± 2.7% for the Krebs-Henseleit, the Krebs-Henseleit with pinacidil and glibenclamide, the St. Thomas' Hospital, and the Krebs-Henseleit with pinacidil groups, respectively. No hearts had ventricular fibrillation on reperfusion.

Conclusions: During hypothermic hyperpolarized arrest, as opposed to normothermic ischemia as in our previous studies, there was neither an increased incidence of ventricular fibrillation nor prolonged electrical activity when compared with results during traditional hyperkalemic arrest. Myocardial protection by St. Thomas' Hospital solution and pinacidil was superior (p = 0.009) to that with Krebs-Henseleit solution alone. The protection provided by pinacidil was lost with the addition of glibenclamide, indicating that the drug has adenosine triphosphate–sensitive potassium channel activity during hypothermia.

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