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The Journal of Thoracic and Cardiovascular Surgery, Vol 93, 163-172, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
AF Corno, DM Bethencourt, H Laks, GS Haas, S Bhuta, HG Davtyan, WM Flynn, DC Drinkwater, C Laidig and P Chang
Myocardial protection achieved during 2 hours of ischemic arrest was
evaluated in 45 isolated, blood perfused, neonatal (1 to 5 days) piglet
hearts. Comparisons were made among five methods of myocardial protection:
Group I, topical cooling; Group II, hyperosmolar (450 mOsm) low-calcium
(0.5 mmol/L) crystalloid cardioplegia; Group III, St. Thomas' Hospital
cardioplegia; Group IV, cold blood cardioplegia with potassium (21 mmol/L),
citrate-phosphate-dextrose (calcium level 0.6 mmol/L), and tromethamine;
and Group V, cold blood cardioplegia with potassium alone (16 mmol/L)
(calcium level 1.2 mmol/L). Hemodynamic recovery (percent of the
preischemic stroke work) after 30 and 60 minutes of reperfusion was 82.9%
and 86.7% in Group I, 35.7% (p less than 0.0001) and 43.7% (p less than
0.0001) in Group II, 76.1% and 77.7% in Group III, 67.4% (p less than 0.05)
and 60.6% (p less than 0.05) in Group IV, and 110.7% and 100.6% in Group V.
Conclusions: Topical cooling is an effective method of myocardial
protection in the neonate. Cold blood cardioplegia with potassium alone and
a normal calcium level provides optimal functional recovery. The improved
protection obtained with both crystalloid and blood cardioplegia with
normal calcium levels suggests an increased sensitivity of the neonatal
heart to the calcium level of the cardioplegic solution.
ARTICLES
Myocardial protection in the neonatal heart. A comparison of topical hypothermia and crystalloid and blood cardioplegic solutions
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