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The Journal of Thoracic and Cardiovascular Surgery, Vol 92, 621-635, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
BS Allen, F Okamoto, GD Buckberg, H Bugyi, H Young, J Leaf, F Beyersdorf, F Sjostrand and JV Maloney Jr
This study tests the hypothesis that irreversible muscle damage does not
occur after as long as 6 hours of ischemia before reperfusion, immediate
functional recovery is possible by controlling the conditions of
reperfusion during total vented bypass and the composition of the
reperfusate with substrate-enriched blood cardioplegic solution, and such
control can be accomplished without thoracotomy. Of 43 dogs undergoing 2 to
6 hours of left anterior descending coronary occlusion, seven were studied
by ultrastructural and mitochondrial analyses after 6 hours of regional
coronary occlusion without reperfusion. Sixteen other dogs were reperfused
with normal blood, with the heart in the beating state after 2 to 4 hours
of ischemia, and 20 dogs received regional substrate-enriched blood
cardioplegic reperfusion after 2 to 6 hours of ischemia for 20 minutes
during total vented bypass accomplished through the femoral artery, femoral
vein, and transaortic left ventricular venting. Six hours of ischemia
without reperfusion caused minimal changes in mitochondrial structure and
retained mitochondrial adenosine triphosphate production capacity at 64% of
control values despite complete depletion of tissue adenosine triphosphate.
Reperfusion with normal blood in the beating, working hearts caused
extensive structural damage, reduced reflow, and failed to restore
contractility in any instance (-27% systolic shortening, p less than 0.05).
In contrast, regional cardioplegic reperfusion during total vented bypass
at 2, 4, and 6 hours caused 52 +/- 3%, 41 +/- 7%, and 21 +/- 6% immediate
recovery of regional contractile function. The seven hearts reperfused at 6
hours of ischemia had more segmental shortening (21% versus -27%, p less
than 0.05), less edema (81% versus 83% water content, p less than 0.05),
and more postischemic flow (57 versus 18 ml/100 gm/min in subendocardial
muscle, p less than 0.05) than did 2-hour controls, and postischemic
ultrastructure was not altered by reperfusion. Six hours of ischemia does
not produce irreversible damage, and immediate recovery of contractile
function is possible if the conditions of reperfusion are controlled with
total vented bypass and a regional substrate-enriched blood cardioplegic
solution is administered. Such control can be obtained by the peripheral
cannulation technique.
ARTICLES
Immediate functional recovery after six hours of regional ischemia by careful control of conditions of reperfusion and composition of reperfusate
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