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The Journal of Thoracic and Cardiovascular Surgery, Vol 92, 564-572, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Reperfusate composition: benefits of marked hypocalcemia and diltiazem on regional recovery

BS Allen, F Okamoto, GD Buckberg, C Acar, M Partington, H Bugyi and J Leaf

This study tests the hypothesis that improved muscle salvage is possible by markedly reducing the ionic calcium (Ca++) of the reperfusate (less than 250 mumol/L) and adding a calcium channel- blocking drug (diltiazem). Preliminary pilot studies showed that a 20- minute infusion of markedly hypocalcemic substrate-enriched blood cardioplegic solution (less than 250 mumol/L Ca++) did not affect left ventricular function adversely and that a 150 to 250 mumol/L substrate- enriched blood cardioplegic solution, delivered during total vented bypass with diltiazem, 300 micrograms/kg body weight, produced the most consistent functional recovery and the least histochemical evidence of damage (triphenyltetrazolium chloride nonstaining) after 2 hours of regional ischemia. Experimental studies of 2 hours of regional ischemia were followed by either regional normocalcemic (1000 to 1200 mumol/L) blood cardioplegic reperfusion in bypassed hearts, with or without diltiazem, or hypocalcemic (150 to 150 mumol/L) blood cardioplegic reperfusion with diltiazem for 20 minutes. Results showed that hypocalcemic blood cardioplegic solution with diltiazem produced superior recovery of systolic shortening (58% versus 11% systolic shortening, p less than 0.05) and limitation of histochemical damage (11% versus 54%, p less than 0.05), in comparison with normocalcemic blood cardioplegic solution without diltiazem. These studies suggest that modifying the regional reperfusate by markedly reducing ionic calcium levels and adding calcium channel-blocking drugs is safe and may improve myocardial salvage more than using substrate-enriched blood cardioplegic solution alone.


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