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The Journal of Thoracic and Cardiovascular Surgery, Vol 101, 314-325, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
LA Robinson and DL Harwood
The concentration of calcium (1.2 mmol/L) in clinical St. Thomas' Hospital
cardioplegic solution was chosen several years ago after dose- response
studies in the normothermic isolated heart. However, recent studies with
creatine phosphate in St. Thomas' Hospital solution demonstrated that
additional myocardial protection during hypothermia resulted principally
from its calcium-lowering effect in the solution. The isolated working rat
heart model was therefore used to establish the optimal calcium
concentration in St. Thomas' Hospital solution during lengthy hypothermic
ischemia (20 degrees C, 300 minutes). The calcium content of standard St.
Thomas' Hospital solution was varied from 0.0 to 1.5 mmol/L in eight
treatment groups (n = 6 for each group). During ischemia, hearts were
exposed to multidose cardioplegia (3 minutes every 30 minutes).
Postischemic recovery of function was expressed as a percentage of
preischemic control values. Release of creatine kinase and the time to
return of sinus rhythm during the reperfusion period were also measured.
These dose-response studies during hypothermic ischemia revealed a broad
range of acceptable calcium concentrations (0.3 to 0.9 mmol/L), which
appear optimal in St. Thomas' Hospital solution at 0.6 mmol/L. This
concentration improved the postischemic recovery of aortic flow from 22.0%
+/- 5.9% with control St. Thomas' Hospital solution (calcium concentration
1.2 mmol/L) to 86.0% +/- 4.0% (p less than 0.001). Other indices of
functional recovery showed similar dramatic results. Creatine kinase
release was reduced 84% (p less than 0.01) in the optimal calcium group.
Postischemic reperfusion arrhythmias were diminished with the loser calcium
concentration, with a significant decrease in the time between initial
reperfusion until the return of sinus rhythm. In contrast, acalcemic St.
Thomas' Hospital solution precipitated the calcium paradox with massive
enzyme release and no functional recovery. Unlike prior published calcium
dose-response studies at normothermia, these results demonstrate that the
optimal calcium concentration during clinically relevant hypothermic
ischemia is considerably lower than that of normal serum ionized calcium
(1.2 mmol/L) and appears ideal at 0.6 mmol/L to realize even greater
cardioprotective and antiarrhythmic effects with St. Thomas' Hospital
solution.
ARTICLES
Lowering the calcium concentration in St. Thomas' Hospital cardioplegic solution improves protection during hypothermic ischemia
Department of Surgery, University of Nebraska Medical Center, Omaha 68198-2315.
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E. L. Bove and K. P. Gallagher Reply Ann. Thorac. Surg., June 1, 1991; 51(6): 1044 - 1044. [PDF]
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L. A. Robinson Calcium in neonatal cardioplegia Ann. Thorac. Surg., June 1, 1991; 51(6): 1043 - 1044. [PDF]
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