Protecting the aged heart during cardiac surgery: Use of del Nido cardioplegia provides superior functional recovery in isolated hearts
| Autor: | Rui Hua, Robert A. Rose, Camille L. Hancock Friesen, Stacy B. O'Blenes, Arun Govindapillai |
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| Rok vydání: | 2013 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine Aging Cardiac output medicine.medical_specialty Lidocaine Myocardial Reperfusion Injury In Vitro Techniques 030204 cardiovascular system & hematology Sodium Channels 03 medical and health sciences 0302 clinical medicine Older patients Internal medicine Spontaneous contraction medicine Animals Myocytes Cardiac Cardiac Output Cardiac Surgical Procedures Cardioplegic Solutions Window current biology business.industry Sodium Age Factors Recovery of Function Functional recovery Myocardial Contraction Troponin Rats Inbred F344 Rats Cardiac surgery Perfusion Kinetics 030228 respiratory system Anesthesia Heart Arrest Induced Cardiology biology.protein Surgery Cardiology and Cardiovascular Medicine business Biomarkers Sodium Channel Blockers medicine.drug |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 146:940-948 |
| ISSN: | 0022-5223 |
| Popis: | Objectives Aged hearts are particularly vulnerable to ischemia-reperfusion injury. Our objective was to determine if del Nido cardioplegia, which contains lidocaine, less blood, and less calcium than our standard cardioplegia, provides superior protection for aged hearts. We also sought to determine if the lidocaine in del Nido cardioplegia is adequate to prevent Na + influx via the window current. Methods Sodium channel kinetics were measured in rat cardiomyocytes with and without lidocaine. Recovery after 60 minutes of cardioplegic arrest was assessed in isolated working senescent rat hearts. Del Nido cardioplegia was delivered as a single dose (n = 8) because it is used clinically, and standard cardioplegia was delivered as an induction dose with re-dosing every 20 minutes (n = 8). After 20 minutes of reperfusion, hearts were switched to working mode for 60 minutes. Flows were indexed to ventricular dry weight. Troponin release was assayed. Results Sodium channel kinetics indicated that the lidocaine concentration in del Nido cardioplegia minimizes the potential for Na+ influx via the window current. Spontaneous contractions occurred in fewer hearts arrested with del Nido cardioplegia (88% vs 13%; P = .01), and troponin release was reduced (0.24 vs 0.89 ng/mL; P = .017). Cardiac output was approximately 90% of baseline in the del Nido group compared with approximately 50% in the standard group (173 ± 14 vs 86 ± 22 mL · min −1 · g −1 ; P = .0008). Stroke work was higher in the del Nido group (93 ± 6 vs 41 ± 10 mL · mm Hg · g −1 ; P = .0002). Conclusions Del Nido cardioplegia prevents spontaneous contractions during arrest, reduces troponin release, and results in superior myocardial function in isolated aged hearts. Del Nido cardioplegia has the potential to provide superior myocardial protection for older patients undergoing cardiac surgery. |
| Databáze: | OpenAIRE |
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