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The Journal of Thoracic and Cardiovascular Surgery, Vol 89, 531-546, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
SE Fremes, RD Weisel, DA Mickle, J Ivanov, MM Madonik, SJ Seawright, S Houle, PR McLaughlin and RJ Baird
Transient alterations in myocardial metabolism and ventricular function
were observed after elective coronary bypass grafting despite apparently
adequate intraoperative protection with cold potassium cardioplegia. Ninety
patients had serial hemodynamic measurements and coronary sinus catheters
inserted. Thirty-three patients had thermodilution coronary sinus flow
catheters inserted to measure coronary sinus blood flow and to evaluate the
myocardial utilization of oxygen and lactate. Nuclear ventriculograms were
performed in 43 patients to assess ventricular function. Cardiac index fell
after discontinuation of cardiopulmonary bypass and then rose between 2 and
24 hours postoperatively. Myocardial oxygen consumption steadily increased
during this period. Myocardial lactate production reverted to lactate
extraction 30 minutes after reperfusion. Reactive hyperemia was present
during the first 10 minutes after cross-clamp release, and coronary sinus
blood flow increased gradually during the first 24 hours postoperatively.
The response to the stress of volume loading (the infusion of 250 to 500 ml
of a colloid solution) and atrial pacing (at a rate of 110 beats/min) was
evaluated 2 to 4 hours postoperatively (EARLY) and between 4 to 6 hours
postoperatively (LATE). Volume loading resulted in a decrease in lactate
extraction EARLY and an increase LATE (EARLY: -0.07 +/- 0.35 mmol/L; LATE:
0.08 +/- 0.32 mmol/L, mean +/- standard deviation not significant). Atrial
pacing resulted in a decrease in lactate extraction EARLY and an increase
LATE (EARLY: -0.11 +/- 0.34 mmol/L; LATE: 0.14 +/- 0.36 mmol/L, p less than
0.05). Diastolic compliance (the relation between the end-diastolic volume
index) decreased between EARLY and LATE. Systolic function (the relation
between the systolic blood pressure and the end-systolic volume index) and
myocardial performance (the relation between the left ventricular stroke
work index and the end-diastolic volume index) were unchanged. Ejection
fraction correlated inversely with the end- diastolic volume index and did
not represent an independent index of contractility. After elective
coronary bypass grafting and cold crystalloid cardioplegia, myocardial
metabolism recovered slowly. Hemodynamic stresses should be avoided in the
early postoperative period to prevent progressive ischemic injury.
ARTICLES
Myocardial metabolism and ventricular function following cold potassium cardioplegia
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