Simultaneous antegrade and retrograde delivery of continuous warm blood cardioplegia after global ischemia.

OBJECTIVE: Simultaneous delivery of antegrade and retrograde cardioplegia may provide a more homogeneous distribution of cardioplegic solution. It may, however, increase myocardial edema and postcardioplegic myocardial injury. The purpose of this study was to compare simultaneous antegrade-retrograde cardioplegia with antegrade cardioplegia. METHODS: After 30 minutes of warm, "unprotected," global ischemia, pigs were given warm, continuous blood cardioplegia for 45 minutes (antegrade group, n = 8 and simultaneous antegrade-retrograde group, n = 9). All pigs were weaned from cardiopulmonary bypass 45 to 60 minutes after aortic unclamping. Indices of left ventricular function were measured after another 30 minutes with the conductance catheter technique and pressure-volume loops. RESULTS: Global left ventricular function, evaluated by preload recruitable stroke work, decreased from baseline values of 126 (102 to 150) (mean [90% confidence limits]) (antegrade) and 122 (116 to 127) erg/ml x 10(3) (simultaneous) to 75 (61 to 89) (p = 0.004) and 95 (79 to 112) erg/ml x 10(3) (p = 0.02), respectively. End-diastolic pressure-volume relation increased from 0.25 (0.21 to 0.28) (antegrade) and 0.30 (0.25 to 0.35) mm Hg/ml (simultaneous) to 0.60 (0.41 to 0.79) (p = 0.009) and 0.53 (0.35 to 0.71) mm Hg/ml (p = 0.02), respectively. The time constant of left ventricular pressure relaxation was unchanged. No intergroup difference was observed in preload recruitable stroke work, preload recruitable stroke work area, end-diastolic pressure volume relation, or stiffness constant. Plasma levels of troponin T increased without any difference between groups. Myocardial water content was increased in the simultaneous group (81.1% [80.7% to 81.5%]) versus the antegrade group (80.1% [79.6% to 80.7%], p = 0.01). CONCLUSION: Despite a small increase in myocardial water content induced by simultaneous blood cardioplegia, no impairment of postcardioplegic cardiac function was observed compared with antegrade cardioplegia.

Warm or cold continuous blood cardioplegia provides similar myocardial protection.

BACKGROUND: This study was performed to investigate the effect of temperature of blood cardioplegia on the recovery of postischemic cardiac function. METHODS: Pigs on cardiopulmonary bypass were subjected to global ischemia (30 minutes), followed by cold (n = 10) or warm (n = 11) continuous antegrade blood cardioplegia (45 minutes) delivered at 55-60 mm Hg. RESULTS: Global left ventricular function, evaluated by preload recruitable stroke work, decreased with cold cardioplegia from 91 (85-103) [mean (quartile interval)], at baseline, to 73 (55-87) erg x 10(3)/mL postbypass (p = 0.03), but was unchanged after warm cardioplegia; 110 (80-132) to 109 (71-175) erg x 10(3)/mL (p > 0.5). However, the difference between treatment effects was not significant (p = 0.25). Diastolic function, evaluated by end-diastolic pressure-volume relation, deteriorated without any difference between groups. Mean cardioplegic flow was similar between groups. Coronary vascular resistance increased at constant rate during warm cardioplegic delivery, but remained unchanged with cold cardioplegia (p = 0.001 between regression coefficients). CONCLUSIONS: No significant difference was found in postischemic functional recovery comparing cold and warm continuous blood cardioplegia. Cold cardioplegia is therefore preferred due to added safety of hypothermia.

Intermittent warm blood cardioplegia does not provide adequate myocardial resuscitation after global ischaemia.

OBJECTIVE: Intermittent warm blood cardioplegia is controversial, and many surgeons consider it inadequate for myocardial protection. The purpose of this study was to compare intermittent and continuous warm blood cardioplegia as resuscitation in hearts exposed to global ischaemia. METHODS: Pigs were put on cardiopulmonary bypass (CPB) and subjected to 30 min of warm, "unprotected", global ischaemia, followed by continuous (n = 7) or intermittent (n = 10, 12 ml/kg every 10 min) warm (34 degrees C) antegrade blood cardioplegia for 45 min (delivery pressure 75-80 mmHg) and weaned from CPB 45 to 60 min later. Indices of left ventricular function were acquired with the conductance catheter technique and pressure-volume loops at baseline and after 90 min of reperfusion. RESULTS: Cardioplegia was delivered during 17% of the cross-clamp time. Global left ventricular function, evaluated by preload recruitable stroke work (PRSW), was unchanged after continuous cardioplegia; 95 (76-130) (median (quartile interval)) to 91 (90-104) erg/ml x 10(3), but decreased after intermittent cardioplegia; 122 (100-128) to 64 (23-93) erg/ml x 10(3). Two pigs in the intermittent group weaned from CPB, but died before post-bypass measurement. A 95% confidence interval for the difference in post-bypass mean PRSW was estimated as 32 +/- 30 erg/ml x 10(3) (corresponding to P = 0.04 for comparison between treatments). The end-diastolic pressure-volume relation (EDPVR) increased from 0.17 (0.14-0.20) (continuous) and 0.15 (0.12-0.22) (intermittent) mmHg/ml to 0.27 (0.22-0.33) (P = 0.018) and 0.39 (0.25-0.66) (P = 0.005) mmHg/ml, respectively, indicating deterioration in diastolic function. No difference between groups was found in EDPVR, stiffness constant, troponin T release or myocardial water content. CONCLUSION: Following acute global ischaemia left ventricular global function was, in this model, less preserved using warm intermittent compared to warm continuous cardioplegia.

Correlation between a mid-ventricular volume segment and global left ventricular volume measured by the conductance catheter.

OBJECTIVES: To investigate whether acute volume changes in single volume segments of the left ventricle can be correlated with global volume changes. If so, changes in global volume might be predicted from changes in segmental volumes. DESIGN: Volume changes were recorded in six pigs in five intraventricular segments, from apex to heart base, using the conductance catheter (at baseline, after 60 min of apical ischaemia, during preload reduction and afterload increase). A computer algorithm was created to calculate the instantaneous absolute difference between the curve shape of global and normalized segmental volume as a percentage of global stroke volume. RESULTS: For a mid-cardiac volume segment constituting 34 (14-39)% [median (range)] of global stroke volume, the mean difference over a cardiac cycle was 4 (1-8)% at baseline. Apical ischaemia resulted in apical dyskinesia, but did not influence the mid-cardiac segment. CONCLUSIONS: The volume curve from a segment at mid-cardiac level seems to be a good estimator of the global volume curve, thus giving a foundation for estimation of global volume changes from such a segment.