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J Thorac Cardiovasc Surg 2000;120:660-667
© 2000 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
From the Cardiac Surgical Research Unit,a Alfred Hospital, Baker Medical Research Institute, and the Department of Surgery, Monash University; the Department of Epidemiology and Preventative Medicine,b Monash University; and the Department of Biochemistry and Molecular Biology,c Monash University, Melbourne, Australia.
Supported in part by Rothschild Australia. Dr J. Mariani was supported by a Monash University Bachelor of Medical Science Scholarship and an Alfred Hospital Medical Scholarship. Dr S. Pepe was supported in part by the National Heart Foundation of Australia. Dr F. Rosenfeldt is an National Health and Medical Research Council Principal Research Fellow.
Address for reprints: Franklin Rosenfeldt, MD, FRACS, Associate Professor, Cardiac Surgical Research Unit, Alfred Hospital & Baker Medical Research Institute, PO Box 6492, St Kilda Rd Central, Melbourne, Victoria 8008, Australia (E-mail: f.rosenfeldt{at}alfred.org.au).
Background: Recovery of cardiac function after cardiac surgery and other interventional cardiac procedures in elderly patients is inferior to that in younger patients, suggesting that the aged myocardium is more sensitive to ischemia and other stresses. Although convincing data from animal studies of senescence now exist, there is a dearth of controlled in vitro studies that examine the specific response of aged human myocardium to the stress of hypoxia or ischemia.
Objective: We sought to determine the effect of age on the capacity of human atrial trabeculae to recover contractile function after in vitro hypoxic or ischemic stress.
Methods: Atrial pectinate trabeculae were dissected from the tip of 58 right atrial appendages harvested during an operation in patients aged between 34 and 89 years and electrically stimulated at 1 Hz in oxygenated Ringer's solution at 37°C. Tissues experienced 30 minutes of either hypoxia (N2 and perfusate) or simulated ischemia (humidified N2 without perfusate) and were returned to normoxia for recovery of function for 30 minutes. Developed force and other contractile variables were determined during each period.
Results: Under normoxic conditions, no significant age difference was observed for any contractile function variable. However, after hypoxia, the old (70-89 years) and intermediate age groups (60-69 years) showed reduced recovery of developed force (48.5% ± 22.2% [n = 11] and 44.9% ± 19% [n = 12], respectively) compared with that found (66.4% ± 19.7% [n = 15]) in the younger (34-59 years) group (mean ± SD, P = .02). Similarly, after simulated ischemia, the groups of 70- to 89-year-old and 60- to 69-year-old subjects showed reduced recovery of developed force (35.7% ± 17% [n = 5] and 51.1% ± 11.8% [n = 9], respectively) compared with that found (68.2% ± 10.4% [n = 6]) in the group of 34- to 59-year-old subjects (P = .01). Multivariable analysis, comparing 20 factors of surgical patient characteristics and recovery of developed force, found that only age (P = .01) and hypertension (P = .01) were predictors of reduced recovery of developed force after either hypoxia or simulated ischemia.
Conclusions: In aged human atrial myocardium, the capacity to recover contractile function after in vitro hypoxia or simulated ischemia is reduced compared with the younger myocardium of mature adults. These findings suggest that enhanced myocardial protective strategies may be indicated for elderly patients undergoing cardiac surgery.
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