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J Thorac Cardiovasc Surg 1994;108:772-779
© 1994 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

Prolonged neonatal myocardial preservation with a highly buffered low-calcium solution

Pittsburgh, Pa.

Supported in part by National Institutes of Health grant R29-HL46207 (Dr. del Nido), the International Anesthesia Research Society B.B. Sankey Anesthesia Advancement Award (Dr. McGowan), and Children's Hospital of Pittsburgh.

Received for publication Dec. 12, 1993. Accepted for publication May 2, 1994. Address for reprints: Francis X. McGowan, Jr., MD, Children's Hospital of Pittsburgh, Department of Anesthesiology, 3705 Fifth Ave. at DeSoto St., Pittsburgh, PA 15213-2583.

Abstract

Optimal methods of myocardial preservation remain controversial in the neonate. This study compared prolonged hypothermic storage of neonatal hearts with modified University of Wisconsin solution (group I) with a solution formulated to promote anaerobic glycolysis by providing proton buffering with histidine (100 mmol/L) and exogenous glucose and insulin (group II). Hearts from piglets aged 3 to 5 days were given a single dose of either solution (n = 6 each), subjected to 20 hours of global ischemia at 4° C, and reperfused with an erythrocyte-enhanced perfusate in an isovolumic Langendorff preparation. After 1 hour of reperfusion, in comparison with hearts preserved with University of Wisconsin solution, those in group II demonstrated (mean ± standard error of the mean) greater left ventricular developed pressure (101 ± 7 versus 62 ± 9 mm Hg, p < 0.01) and the first derivative of left ventricular pressure (816 ± 23 versus 614 ± 69 mm Hg·sec ^-1, p < 0.05). Diastolic indices were reduced to a similar degree in the two groups. Myocardial oxygen consumption was significantly greater (38.8 ± 2.4 versus 11.8 ± 2.4µl oxygen·min·g ^-1, p < 0.01) in group II hearts. Group I hearts vasoconstricted (6% increase in coronary vascular resistance) in response to an intracoronary infusion of acetylcholine (20 nmol·min ^-1); in contrast, acetylcholine produced coronary dilation in group II hearts (5% decrease in coronary resistance, p < 0.02) that was similar to that observed in nonischemic control hearts. These results demonstrate enhanced preservation of myocardial contractility, oxidative metabolism, and vascular function in neonatal hearts provided by a solution designed to buffer protons and promote anaerobic glycolysis during ischemia. (J THORACCARDIOVASCSURG1994;108:772-9)

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