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J Thorac Cardiovasc Surg 1995;109:466-472
© 1995 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

Coronary flow reserve after ischemia and reperfusion of the isolated heartDivergent results with crystalloid versus blood perfusion

Detroit, Mich.

Presented in part at the Forty-ninth Annual Sessions of the Forum on Fundamental Surgical Problems, 1993 Clinical Congress, San Francisco, Calif., October 10-15.

Received for publication March 10, 1994. Accepted for publication July 22, 1994. Address for reprints: Norman A. Silverman, MD, Division Head, Cardiac and Thoracic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202.

Abstract

Mechanical function and coronary hemodynamics were assessed in 73 isolated rabbit hearts randomly subjected to 0, 10, 20, 30, or 45 minutes of 37 degrees C global ischemia and 45 minutes of reperfusion in either a modified Krebs buffer or homologous blood-perfused Langendorff mode (n = 7 to 9 hearts per group). Isovolumic developed pressure, resting coronary flow, and response to endothelium-dependent (bradykinin) and -independent (nitroglycerin) agonists were quantitated at defined preload and heart rate. Perfusate did not influence systolic performance, which was impaired after 30 minutes of ischemia and fell to 64% to 72% of preischemic values after 45 minutes of ischemia (p < 0.05). However, basal coronary flow was at least sixfold greater in crystalloid-perfused hearts. Moreover, coronary hyperemia (p < 0.05) persisted for Krebs-perfused hearts subjected to all but the longest ischemic interval. After equilibration, all postischemic blood-perfused hearts had basal flow unchanged from before ischemia. Bradykinin and nitroglycerin induced similar increases in coronary flow for each group before and after each ischemia interval. However, the magnitude of this increase was greater in blood-perfused hearts (p < 0.01) and was not attenuated by the ischemic times encompassed in this protocol. In contrast, endothelium-dependent and -independent coronary flow reserve was abolished after 20 minutes of ischemia or longer in Krebs-perfused hearts. These data suggest that the unphysiologic resting flow patterns of crystalloid-perfused isolated hearts obfuscate interpretation of the interaction between coronary flow reserve and ischemic injury. (J THORAC CARDIOVASC SURG 1995; 109: 466-72)

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