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J Thorac Cardiovasc Surg 1994;107:1512-1518
© 1994 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

Single-dose versus multidose cardioplegia in neonatal hearts

Syracuse, N.Y.

Supported in part by the American Heart Association–New York Affiliate and the Hendricks Foundation, State University of New York.

Received for publication July 30, 1993. Accepted for publication Oct. 25, 1993. Address for reprints: Leslie J. Kohman, MD, Department of Surgery, SUNY Health Science Center, 750 East Adams St., Syracuse NY 13210.

Abstract

We designed an experiment to compare single-dose versus multidose cardioplegia (calcium 0.3 mmol/ L) in neonatal rabbit hearts 1, 4 and 6 weeks of age at 25° C and 32° C. Isolated hearts had a stabilization period of retrograde perfusion, a working period, a period of ischemia with single or multidose cardioplegia, reperfusion, and a final working period. We measured hemodynamic recovery, creatine kinase during reperfusion, and coronary vascular resistance during administration of the cardioplegic solution. One-week and 4-week-old hearts exhibited better recovery with single-dose than with multidose cardioplegia. Six-week-old hearts, on the other hand, showed better recovery with multidose cardioplegia. Four-week-old hearts at 25° C showed increased creatine kinase release with multidose cardioplegia. The 6-week-old hearts tended toward lower creatine kinase release with multidose cardioplegia. Coronary vascular resistance rose with subsequent administrations in 1-week and 4-week-old hearts at 25° C but did not rise in 1- and 4-week-old hearts at 32° C or in 6-week-old hearts at either temperature. On the basis of hemodynamic recovery, single-dose cardioplegia appears to provide better protection than multidose cardioplegia to 1- and 4-week-old isolated rabbit hearts. Once the rabbit has reached 6 weeks of age, multidose cardioplegia has some advantage over single-dose cardioplegia, similar to the findings in adult hearts. Creatine kinase release and coronary vascular resistance data corroborate the hemodynamic findings. (J T HORAC C ARDIOVASC S URG 1994;107:1512-8)

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