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The Journal of Thoracic and Cardiovascular Surgery, Vol 95, 788-798, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
KH Teoh, DA Mickle, RD Weisel, MM Madonik, J Ivanov, RD Harding, AD Romaschin and JC Mullen
The myocardial oxidation of fatty acids and glucose, the predominant
substrates for aerobic metabolism, is impaired after cardioplegic arrest
for coronary revascularization. Because lactate can be readily metabolized
to pyruvate, it may be the preferred substrate for aerobic metabolism after
cardioplegic arrest when arterial concentrations are elevated. Nineteen
patients undergoing elective coronary revascularization with blood
cardioplegia were randomized to receive LOW (nine patients, no exogenous
lactate) or HIGH (10 patients, a perioperative infusion of Ringer's
lactate) arterial lactate concentrations. Coronary sinus catheterization
and lactate labeled with carbon 14 permitted calculation of myocardial
oxygen consumption and lactate oxidation which were significantly increased
during reperfusion in the group with HIGH arterial lactate concentrations.
Atrial pacing at 110 beats/min on cardiopulmonary bypass resulted in
myocardial lactate production (suggesting ischemic anaerobic metabolism) in
the LOW lactate group, but atrial pacing increased lactate consumption and
oxidation in the HIGH lactate group (suggesting increased aerobic
metabolism). Systolic function (the relation between end-systolic pressure
and volume) as assessed by nuclear ventriculography 3 hours postoperatively
was significantly better (p less than 0.05 by analysis of covariance) in
the HIGH lactate group. Postoperative myocardial creatine kinase release
was significantly lower in the HIGH lactate group, which suggested less
perioperative ischemic injury. Lactate was the preferred substrate for
myocardial oxidative metabolism after cardioplegic arrest, and the higher
arterial lactate concentrations improved myocardial metabolic and
functional recovery and reduced perioperative ischemic injury.
ARTICLES
Improving myocardial metabolic and functional recovery after cardioplegic arrest
Division of Cardiovascular Surgery, Toronto General Hospital, Ontario, Canada.
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