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The Journal of Thoracic and Cardiovascular Surgery, Vol 84, 667-677, Copyright © 1982 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
ER Rosenkranz, J Vinten-Johansen, GD Buckberg, F Okamoto, H Edwards and H Bugyi
This study tests the hypothesis that warm induction of cardioplegia prior
to prolonged maintenance by multidose infusions of cold blood cardioplegic
solution would increase the tolerance of energy-depleted hearts to
subsequent aortic clamping. Eighty percent depletion of subendocardial
adenosine triphosphate (ATP) was produced in 30 dogs by 45 minutes of
normothermic ischemia. This was followed either by unmodified blood
reperfusion or 2 additional hours of aortic clamping with multidose cold
blood cardioplegia. We compared a brief (5 minute) period of 37 degrees C
cardioplegic induction to standard 4 degrees C blood cardioplegic induction
to determine if warm induction would enhance metabolic and functional
recovery. Warm cardioplegic induction resulted in more oxygen consumption
than cold induction (16.9 versus 8.1 cc/100 gm), and lower levels of
glucose-6-phosphate (G6P), suggesting better aerobic metabolism (0.97
versus 1.87 microM/gm wet weight). Prompt repletion of creatine phosphate
(CP) occurred with warm and cold cardioplegic induction, although ATP
levels levels remained low. Hearts undergoing ischemia and unmodified
reperfusion consumed insufficient oxygen to meet basal metabolic needs
during reperfusion (7 cc/100 gm below requirement) and recovered only 33%
+/- 5% of control left ventricular performance. Better function occurred
with cold cardioplegic induction (63% +/- 5%), and almost complete recovery
(85% +/- 5%) occurred when warm induction of cardioplegia was used. We
conclude that warm induction followed by prolonged cold multidose blood
cardioplegic arrest enhances aerobic metabolism, results in normal left
ventricular performance, and improves tolerance of aortic clamping in
energy-depleted hearts.
ARTICLES
Benefits of normothermic induction of blood cardioplegia in energy- depleted hearts, with maintenance of arrest by multidose cold blood cardioplegic infusions
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