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The Journal of Thoracic and Cardiovascular Surgery, Vol 85, 769-780, Copyright © 1983 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RM Bodenhamer, LW DeBoer, GA Geffin, DD O'Keefe, JT Fallon, TH Aretz, GS Haas and WM Daggett
To determine if, during elective cardiac arrest, the myocardial protection
afforded by a cold (4 degrees C) crystalloid potassium cardioplegic
solution could be improved by oxygenation of the solution, we placed 16
dogs on cardiopulmonary bypass and subjected their hearts to 4 hours of
cold cardioplegic arrest. Group 1 hearts (n = 8) received aerated
crystalloid solution perfused through the aortic root every 20 minutes.
Group 2 hearts (n = 8) were treated identically except that the crystalloid
cardioplegic solution was fully oxygenated. Left ventricular function
curves (ejecting heart) were generated before arrest (control) and after 45
minutes of reperfusion. A cardiac output of 1,000 ml/min could be attained
in only two hearts of Group 1 after reperfusion, whereas all but one heart
of Group 2 had excellent functional preservation. Mean postreperfusion
adenosine triphosphate (ATP) levels in Group 1 and Group 2 hearts were 62%
and 89% of control, respectively (p less than 0.01). Myocardial water
content had increased significantly (p less than 0.002) after reperfusion
in Group 1, but not in Group 2. During cardioplegic solution infusion,
myocardial oxygen consumption (MVO2) was 1.42 +/- 0.15 ml O2/min/100 gm LV
for Group 1 and 6.91 +/- 1.27 ml O2/min/100 gm LV for Group 2 (p less than
0.001). Oxygen consumed per minute of arrest was 0.027 +/- 0.003 ml
O2/min/100 gm LV for Group 1 and 0.128 +/- 0.015 ml O2/min/100 gm LV for
Group 2 (p less than 0.001). Postreperfusion ultrastructural evaluation of
two of the Group 1 hearts revealed severe ischemic damage in contrast to
the normal ultrastructural appearance of two of the Group 2 hearts. With
careful attention given to maintenance of myocardial hypothermia and
cardioplegic delivery methods, the myocardial protection afforded by an
oxygenated crystalloid cardioplegic solution exceeds that provided by the
aerated control and compares favorably with other methods of myocardial
protection during ischemic arrest.
ARTICLES
Enhanced myocardial protection during ischemic arrest. Oxygenation of a crystalloid cardioplegic solution
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  J. R. Handy Jr., B. H. Dorman, M. J. Cavallo, R. B. Hinton, R. C. Roy, F. A. Crawford, and F. G. Spinale DIRECT EFFECTS OF OXYGENATED CRYSTALLOID OR BLOOD CARDIOPLEGIA ON ISOLATED MYOCYTE CONTRACTILE FUNCTION J. Thorac. Cardiovasc. Surg., October 1, 1996; 112(4): 1064 - 1072. [Abstract] [Full Text]
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T. Ko, H. Otani, H. Imamura, K. Omori, and C. Inagaki Role of sodium pump activity in warm induction of cardioplegia combined with reperfusion of oxygenated cardioplegic solution J. Thorac. Cardiovasc. Surg., July 1, 1995; 110(1): 103 - 110. [Abstract] [Full Text]
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 D. W Fried and H. Mohamed Proportioned blood cardioplegia delivery systems- are you del iveri ng the [K+] you expect? Perfusion, September 1, 1993; 8(5): 401 - 407. [Abstract] [PDF]
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G. Staffan, P. Svenmarker, S. K Haggmark, and K E. Jansson A new method for crystalloid cardioplegic oxygenation Perfusion, April 1, 1991; 6(2): 93 - 97. [Abstract] [PDF]
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D. Wheeldon, R. Amar, and D. Bethune Oxygenated crystalloid cardioplegia: a new technique Perfusion, October 1, 1989; 4(4): 297 - 301. [PDF]
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