Surgical revascularization of acute evolving myocardial infarction without blood cardioplegia fails to restore postischemic function in the involved segment
| Autor: | Jakob Vinten-Johansen, A. Robert Cordell, Stephen A. Mills, Kirk B. Faust |
|---|---|
| Rok vydání: | 1987 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Phosphocreatine Myocardial Infarction Anterior Descending Coronary Artery Creatine law.invention chemistry.chemical_compound Adenosine Triphosphate Dogs Body Water law Internal medicine Carnivora medicine Cardiopulmonary bypass Myocardial Revascularization Animals Myocardial infarction Cardiopulmonary Bypass biology business.industry Myocardium Fissipedia Hemodynamics biology.organism_classification medicine.disease Sonomicrometry chemistry Coronary occlusion Anesthesia Cardiology Heart Arrest Induced Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of thoracic surgery. 44(1) |
| ISSN: | 0003-4975 |
| Popis: | This study determines the additional protection provided by multidose hypothermic potassium blood cardioplegia over cardiopulmonary bypass alone following one hour of coronary occlusion. In 19 anesthetized dogs having an open-chest procedure, the left anterior descending coronary artery (LAD) was occluded for one hour, and this resulted in loss of active shortening in the affected zone (sonomicrometry). Cardiopulmonary bypass was established, and the dogs were divided into two groups based on the mode of reperfusion. In 10 dogs, hearts were arrested for one hour with amino acid-enhanced multi-dose blood cardioplegia; the ligatures were removed prior to the second infusion. In the 9 remaining dogs, the ligatures were removed and reperfusion was initiated with unmodified blood on total vented bypass. Both groups were reperfused for one additional hour. Postischemic levels of adenosine triphosphate (ATP) were comparable in the blood cardioplegia and bypass groups, and subendocardial levels averaged 42.8% and 45.8% of controls, respectively. Levels of creatine phosphate returned to control values. Subendocardial water content was significantly less in the blood cardioplegia hearts than the bypass hearts (79.4 +/- 0.5% vs. 81.5 +/- 0.5%; p less than .05); subendocardial water content in the blood cardioplegia group was not different from controls (78.6 +/- 0.1%). Blood cardioplegia restored significantly more fractional shortening than total vented bypass alone (39.3 +/- 9.8% vs. 6.3 +/- 9.1% of control), despite similarities in postischemic levels of ATP. We conclude that blood cardioplegia allows better myocardial salvage in the setting of evolving infarction. Therefore, attention must be directed to both the conditions (bypass, delivery pressure) and composition (cardioplegia) of reperfusion. |
| Databáze: | OpenAIRE |
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