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J Thorac Cardiovasc Surg 1995;109:1146-1154
© 1995 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

Blood cardioplegia enhanced with nitric oxide donor SPM-5185 counteracts postischemic endothelial and ventricular dysfunction

Winston-Salem, N.C.

Supported in part by grant HL46179 (Dr. Vinten-Johansen) from the Heart, Lung and Blood Institute of the National Institutes of Health.

Received for publication March 17, 1994. Accepted for publication August 22, 1994. Address for reprints: Jakob Vinten-Johansen, PhD, Department of Cardiothoracic Surgery, Bowman Gray School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1096.

Abstract

This study tested the hypothesis that enhancement of blood cardioplegia with the nitric oxide donor agent SPM-5185 inhibits postischemic left ventricular and coronary endothelial dysfunction. Eighteen anesthetized dogs supported by total vented bypass were subjected to 30 minutes of normothermic ischemia followed by 4° C multidose blood cardioplegia. Hearts received either standard blood cardioplegia (vehicle group; n = 6), blood cardioplegia with 1µmol/L SPM-5185 (low-dose group; n = 6), or 10µmol/L SPM-5185 (high-dose group; n = 6). After 60 minutes of cardioplegic arrest, the heart was reperfused for a total of 60 minutes, first in the beating empty state for 30 minutes and then after discontinuation of bypass for 30 minutes. Baseline and postischemic left ventricular function was assessed by the slope of the end-systolic pressure-volume (impedance catheter) relation. Postischemic end-systolic pressure-volume relation was depressed by 53.7% of preischemic values in the vehicle group (from 8.2 ± 1.0 to 3.8 ± 0.3 mm Hg/ml) and by 33.7% (from 9.2 ± 1.1 to 6.1 ± 0.5 mm Hg/ml) in the low-dose group. In contrast, there was complete postischemic functional recovery in the high-dose group (from 7.6 ± 1.1 to 7.2 ± 1.2 mm Hg/ml). In coronary arteries isolated from these hearts, endothelium-dependent maximal relaxation to acetylcholine was impaired by 27% in the vehicle group and by 18% in the low-dose group, whereas the high-dose group showed complete endothelium-dependent relaxation. Myeloperoxidase activity, an index of neutrophil accumulation in postischemic myocardium, was elevated in the vehicle and low-dose groups (3.36 ± 0.58 and 2.56 ± 0.68 U/100 mg tissue) but was significantly reduced in the high-dose group to 1.27 ± 0.45 U/100 mg tissue. We conclude that inclusion of 10µmol/L nitric oxide donor SPM-5185 in blood cardioplegia improves postischemic ventricular performance and endothelial function in ischemically injured hearts, possibly via inhibition of neutrophil-mediated damage. (J THORACCARDIOVASCSURG1995;109:1146-54)

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