Efficacy of myocardial protection with hypothermic blood cardioplegia depends on oxygen

Vinten‐Johansen, Jakob; Julian, J. S.; Yokoyama, Hideo; Johnston, William; Smith, Tonya D.; McGee, D.Scott; Cordell, A. Robert

doi:10.1016/0003-4975(91)91259-x

Cited by 17 publications

(6 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly, whole animal hypothermia leads to a depression in heart function during rewarming (29), and substrates such as fatty acids are capable of exacerbating the depression of function after hypothermia and rewarming (20,26). The potential interactions of hypothermia and rewarming with energy substrate metabolism and mechanical function have not been examined despite interest in stimulating oxidative metabolism to improve ATP production through the addition of substrates and O 2 to the cardioplegic medium (5,28) or the use of blood cardioplegia to provide additional O 2 -carrying capacity (30). Because plasma fatty acid levels can rise dramatically during surgery, the practice of using blood cardioplegia may expose the hypothermic heart to high concentrations of fatty acids.…”

Section: Discussionmentioning

confidence: 99%

Effects of hypothermia on energy metabolism in rat and Richardson’s ground squirrel hearts

Belke¹,

Wang

Lopaschuk³

1997

Journal of Applied Physiology

View full text Add to dashboard Cite

Glycolysis, glucose oxidation, palmitate oxidation, and cardiac function were measured in isolated working hearts from ground squirrels and rats subjected to a hypothermia-rewarming protocol. Hearts were perfused initially for 30 min at 37 degrees C, followed by 2 h of hypothermic perfusion at 15 degrees C, after which hearts were rewarmed to 37 degrees C and further perfused for 30 min. Functional recovery in ground squirrel hearts was greater than in rat hearts after rewarming. Hypothermia-rewarming had a similar general effect on the various metabolic pathways in both species. Despite these similarities, total energy substrate metabolic rates were greater in rat than ground squirrel hearts during hypothermia despite a lower level of work being performed by the rat hearts, indicating that rat hearts are less efficient than ground squirrel hearts during hypothermia. After rewarming, energy substrate metabolism recovered completely in both species, although cardiac work remained depressed in rat hearts. The difference in functional recovery between rat and ground squirrel hearts after rewarming cannot be explained by general differences in energy substrate metabolism during hypothermia or after rewarming.

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of hypothermia on energy metabolism in rat and Richardson’s ground squirrel hearts

Belke¹,

Wang

Lopaschuk³

1997

Journal of Applied Physiology

View full text Add to dashboard Cite

show abstract

“…This conclusion correlates with the results of Buttner et al [12] who showed an almost identical paraclinical, clinical, and biochemical outcomes after surgery with blood and crystalloid cardioplegia. Thus, the beneficial effect of blood cardioplegia compared to crystalloid cardioplegia observed by others [3][4][5][6][7][8][9][10][11] must be due to other features than the oxygen carrying capacity of blood. It can be blood buffering capacity [18], antioxidant activity [19], oncotic pressure [20], capillary flow distribution [21], and its metabolic substrate [22].…”

Section: Discussionmentioning

confidence: 93%

“…In recent years, the latter has gained increased interest due to several studies indicating superiority of blood cardioplegia, both experimentally [3][4][5][6] and clinically [7][8][9][10][11]. In several of these studies, it has been suggested that addition of blood to cardioplegic solutions increases oxygen supply to the myocardium.…”

Section: Introductionmentioning

confidence: 98%

Myocardial oxygen tension during surgical revascularization.☆A clinical comparison between blood cardioplegia and crystalloid cardioplegia

Bjerrum

Perko

Beck

2006

European Journal of Cardio-Thoracic Surgery

View full text Add to dashboard Cite

show abstract

“…The desaturated appearance of effluent (coronary venous) blood cardioplegia during the early phase of infusion and intermittent infusions may substantiate this unloading of oxygen from hemoglobin to the myocardium. Oxygen extraction has been observed to occur at 4°C cardioplegia temperatures and may be critical to myocardial protection with blood cardioplegia (33). In a study by Vinten-Johansen et al (33) postischemic left ventricular function in a heart subjected to antecedent nor- mothermic ischemia was improved when blood cardioplegia was fully oxygenated as compared to groups in which it was only partially saturated or nearly desaturated.…”

Section: Reducing Ischemic Injurymentioning

confidence: 99%

Myocardial Protection: An Overview

Vinten-Johansen,

Thourani

2000

J Extra Corpor Technol

View full text Add to dashboard Cite

The goals of myocardial protection during cardiac surgery are not only to facilitate the operation by providing a quiet bloodless field, thereby facilitating the precision of the operation, but also to avoid iatrogenic injury induced by cardiopulmonary bypass itself or by surgically imposed ischemia. In addition, myocardial protective strategies are geared to preventing reperfusion injury upon resolution of the coronary occlusion and the ultimate release of the aortic cross clamp. Cardioplegia plays a very important role in myocardial protection strategies. Acting as a selective perfusion agent, cardioplegia solutions can alter or inhibit ischemic injury by virtue of hypothermia and asystole. In addition, cardioplegia can be used to avoid reperfusion injury by altering the conditions of its delivery and the composition of the solution using various adjunctive agents and pharmacologic therapies for which cardioplegia solutions serve as a vector. Future strategies, particularly for off-pump surgical procedures, may incorporate systemic delivery of therapeutic agents to the heart directly either in conjunction with or without cardioplegia.

show abstract

Efficacy of myocardial protection with hypothermic blood cardioplegia depends on oxygen

Cited by 17 publications

References 35 publications

Effects of hypothermia on energy metabolism in rat and Richardson’s ground squirrel hearts

Effects of hypothermia on energy metabolism in rat and Richardson’s ground squirrel hearts

Myocardial oxygen tension during surgical revascularization.☆A clinical comparison between blood cardioplegia and crystalloid cardioplegia

Myocardial Protection: An Overview

Contact Info

Product

Resources

About