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The Journal of Thoracic and Cardiovascular Surgery, Vol 82, 221-238, Copyright © 1981 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
DM Follette, K Fey, GD Buckberg, JJ Helly Jr, DL Steed, RP Foglia and JV Maloney Jr
This study was designed to determine if ischemic damage could be reduced by
modifying blood composition upon reperfusion. After control data had been
obtained in seven dogs on prolonged cardiopulmonary bypass, 71 dogs
underwent 1 hour of ischemic arrest with topical hypothermia (left
ventricular temperature 16 degrees C). We measured left ventricular
performance (isovolumetric function curves), compliance (intraventricular
balloon), blood flow (microspheres), metabolism (oxygen consumption), and
water content (wet/dry weights) before and 30 minutes after ischemia. The
initial reperfusate was 500 cc of oxygenated blood given over a period of 5
minutes. Without temporary reperfusate modification, postischemic left
ventricular performance was depressed 40% +/- 3%, compliance fell 50% +/-
12%, water content rose 2.5% +/- 0.1%, and left ventricular blood flow and
oxygen uptake increased only minimally when cardiac work was increased
(function curve). These deleterious changes were reduced significantly, but
not prevented, by the following isolated reperfusate modifications: (1)
lowering amount of ionic calcium available for cell entry, (2) raising pH
to 7.8 to counteract acidosis, (3) raising potassium level to maintain
arrest and reduce metabolic demands, and (4) increasing osmolarity
(mannitol, 360 mOsm) to counteract edema. In contrast, by combining these
modifications to achieve a hypocalcemic, hyperkalemic, alkalotic, and
hyperosmolar blood perfusate, it was possible to attain 104% +/- 1%
recovery of myocardial performance, 80% +/- 1% restoration of compliance,
60% less postischemic edema, and near-normal augmentation of left
ventricular flow and oxygen uptake to meet increasing needs.
ARTICLES
Reducing postischemic damage by temporary modification of reperfusate calcium, potassium, pH, and osmolarity
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