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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 280-287, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JE Baker, LE Boerboom and GN Olinger
Hypothermia combined with pharmacologic cardioplegia protects the globally
ischemic adult heart, but this benefit may not extend to children,
resulting in poor postischemic recovery of function and increased
mortality. The relative susceptibilities to ischemia modified by
hypothermia alone and by hypothermia plus cardioplegia were assessed in
isolated perfused neonatal (3- to 4-day-old) rabbit and pig hearts. Hearts
were perfused aerobically with Krebs buffer solution in the working mode
for 30 minutes and aortic flow was recorded. This was followed by 3 minutes
of hypothermic (14 degrees C) coronary perfusion with either Krebs or St.
Thomas' Hospital cardioplegic solution No. 2 followed by hypothermic (14
degrees C) global ischemia (rabbits 2, 4, and 6 hours; pigs 2 and 4 hours).
Hearts were reperfused for 15 minutes in the Langendorff mode and 30
minutes in the working mode, and recovery of postischemic aortic flow was
measured. Hypothermia alone provided excellent protection of the ischemic
neonatal rabbit heart, with recovery of aortic flow after 2 and 4 hours of
ischemia at 91% +/- 4% and 87% +/- 5% (mean +/- standard deviation) of its
preischemic value. Recovery after 6 hours of ischemia was depressed to 58%
+/- 9% of its preischemic value. Ischemic neonatal pig hearts protected
with hypothermia alone recovered 94% +/- 3% of preischemic aortic flow
after 2 hours; none was able to generate flow after 4 hours. St. Thomas'
Hospital solution No. 2 decreased postischemic aortic flow after 4 hours of
ischemia in rabbit hearts from 87% +/- 5% to 70% +/- 7% (p less than 0.05,
hypothermia alone versus hypothermia plus cardioplegia) but improved
postischemic recovery of aortic flow in pig hearts after 4 hours of
ischemia from 0 to 73% +/- 13% (p less than 0.0001, hypothermia alone
versus hypothermia plus cardioplegia). This effect was dose related in both
species. We conclude that the neonatal pig heart is more susceptible to
ischemia modified by hypothermia alone than the neonatal rabbit and that
St. Thomas' Hospital solution No. 2 improves postischemic recovery of
function in the neonatal pig but decreases it in the neonatal rabbit. This
species-dependent protection of the neonatal heart may be related to
differences in the extent of myocardial maturity at the time of study.
ARTICLES
Is protection of ischemic neonatal myocardium by cardioplegia species dependent?
Department of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee.
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J. E. Baker, L. E. Boerboom, and G. N. Olinger Cardioplegia-induced damage to ischemic immature myocardium is independent of oxygen availability Ann. Thorac. Surg., December 1, 1990; 50(6): 934 - 939. [Abstract] [PDF]
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