Protection of the hypertrophied pig myocardium. A comparison of crystalloid, blood, and Fluosol-DA cardioplegia during prolonged aortic clamping

R. J. Novick, H. J. Stefaniszyn, R. P. Michel, F. D. Burdon, Tomas Salerno

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Abstract

The myocardial protective effects of crystalloid, blood, and Fluosol-DA-20% cardioplegia were compared by subjecting hypertrophied pig hearts to 3 hours of hypothermic (10° to 15° C), hyperkalemic (20 mEq/L) cardioplegic arrest and 1 hour of normothermic reperfusion. Left ventricular hypertrophy was created in piglets by banding of the ascending aorta, with increase of the left ventricular weight-body weight ratio from 3.01 ± 0.2 gm/kg (control adult pigs) to 5.50 ± 0.2 gm/kg (p<0.001). An in vivo isolated heart preparation was established in 39 grown banded pigs, which were divided into three groups to receive aerated crystalloid (oxygen tension 141 ± 4 mm Hg), oxygenated blood (oxygen tension 584 ± 41 mm Hg), or oxygenated Fluosol- DA-20% (oxygen tension 586 ± 25 mm Hg) cardioplegic solutions. The use of crystalloid cardioplegia was associated with the following: a low cardioplegia-coronary sinus oxygen content difference (0.6 ± 0.1 vol%), progressive depletion of myocardial creatine phoshate and adenosine triphosphate during cardioplegic arrest, minimal recovery of developed pressure (16% ± 8%) and its first derivative (12% ± 7%), and marked structural deterioration during reperfusion. Enhanced oxygen uptake during cardioplegic infusions was observed with blood cardioplegia (5.0 ± 0.3 vol%), along with excellent preservation of high-energy phosphate stores and significantly improved postischemic left ventricular performance (developed pressure, 54% ± 4%; first derivative of left ventricular pressure, 50% ± 5%). The best results were obtained with Fluosol-DA-20% cardioplegia. This produced high cardioplegia-coronary sinus oxygen content difference (5.8 ± 0.1 vol%), effectively sustained myocardial creatine phosphate and adenosine triphosphate concentrations during the extended interval of arrest, and ensured the greatest hemodynamic recovery (developed pressure, 81% ± 6%, first derivative of left ventricular pressure, 80% ± 10%) and the least adverse morphologic, alterations during reperfusion. It is concluded that oxygenated Fluosol-DA-20% cardioplegia is superior to oxygenated blood and especially aerated crystalloid cardioplegia in protecting the hypertrophied pig myocardium during prolonged aortic clamping.

Original languageEnglish
Pages (from-to)547-566
Number of pages20
JournalJournal of Thoracic and Cardiovascular Surgery
Volume89
Issue number4
StatePublished - Dec 1 1985
Externally publishedYes

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Induced Heart Arrest
Constriction
Myocardium
Swine
Oxygen
Reperfusion
Coronary Sinus
Ventricular Pressure
Pressure
Adenosine Triphosphate
Cardioplegic Solutions
Phosphocreatine
glucose, glycerol, hydroxyethyl starch, perfluorodecalin, perfluorotripropylamine, pluronic F-68, salts, yolk phospholipids drug combination
crystalloid solutions
Creatine
Left Ventricular Hypertrophy
Aorta
Hemodynamics
Phosphates
Body Weight

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Protection of the hypertrophied pig myocardium. A comparison of crystalloid, blood, and Fluosol-DA cardioplegia during prolonged aortic clamping. / Novick, R. J.; Stefaniszyn, H. J.; Michel, R. P.; Burdon, F. D.; Salerno, Tomas.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 89, No. 4, 01.12.1985, p. 547-566.

Research output: Contribution to journalArticle

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