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The Journal of Thoracic and Cardiovascular Surgery, Vol 101, 294-302, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
C Acar, MT Partington and GD Buckberg
This study tests whether initial asanguineous washout of potentially toxic
substances that accumulate during ischemia improves recovery produced by
blood cardioplegic reperfusion and evaluates the role of plasma versus
whole blood cardioplegia. METHODS: Twenty-four dogs underwent 2 hours of
occlusion of the left anterior descending coronary artery and 20 minutes of
blood cardioplegic reperfusion on total vented bypass. In 13 dogs, a
5-minute infusion of either a crystalloid (n = 7) or plasma (n = 6)
cardioplegic solution (containing the same pH, calcium potassium, and
osmolarity as blood cardioplegia) was given immediately before
reoxygenation with blood cardioplegia. Regional oxygen uptake and coronary
vascular resistance were measured during controlled reperfusion, and
segmental shortening (ultrasonic crystals), tissue water content, and
histochemical damage (triphenyltetrazolium chloride stain) were assessed 1
hour after bypass was discontinued. RESULTS: Asanguineous cardioplegic
washout before reoxygenation with blood cardioplegic solution resulted in a
progressive (+42%) increase in coronary vascular resistances (from 123 to
176 units, p less than 0.05) and low oxygen utilization during 20 minutes
of blood cardioplegic reperfusion (29 ml/100 gm, p less than 0.05);
coronary vascular resistance remained low throughout blood cardioplegic
reperfusion without washout (from 109 to 98 units), and oxygen utilization
was 54 ml/100 gm (p less than 0.05). Neither plasma nor crystalloid washout
restored substantial regional systolic shortening (3% systolic shortening
versus 73% systolic shortening with blood cardioplegia), and asanguineous
washout caused more myocardial edema (81.1% +/- 80.9% versus 79.5% water
content, p less than 0.05) and produced extensive transmural
triphenyltetrazolium chloride damage (48% +/- 41% versus 8% nonstaining in
area at risk, p less than 0.05) than initial blood cardioplegic
reperfusion. CONCLUSION: Asanguineous cardioplegic washout before blood
cardioplegic reperfusion limits oxygen utilization during subsequent
controlled reperfusion, restricts early recovery of systolic shortening,
allows more myocardial edema, and produces extensive histochemical damage,
which may be avoided by initial reoxygenation with blood cardioplegia. The
red blood cells appear more important than the plasma components of blood
cardioplegia.
ARTICLES
Studies of controlled reperfusion after ischemia. XX. Reperfusate composition: detrimental effects of initial asanguineous cardioplegic washout after acute coronary occlusion
Department of Surgery, University of California, Los Angeles School of Medicine.
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