Increasing the colloid osmotic pressure of cardiopulmonary bypass prime and normothermic blood cardioplegia minimizes myocardial oedema and prevents cardiac dysfunction.
Our recent work demonstrated that normothermic continuous antegrade blood cardioplegia results in cardiac dysfunction related to myocardial oedema. This oedema was partially due to increased myocardial microvascular fluid filtration induced by crystalloid hemodilution. We hypothesized that increasing the colloid osmotic pressure of blood cardioplegia would stop fluid filtration into the cardiac interstitium, thus preventing myocardial oedema and cardiac dysfunction.


METHODS
We determined myocardial water content in six dogs by microgravimetry and myocardial lymph flow from the major prenodal cardiac lymphatic. Preload recruitable stroke work was derived from sonomicrometry and micromanometry. The dogs were subjected to normothermic cardiopulmonary bypass primed with 6% hetastarch and 1 h of normothermic continuous antegrade blood cardioplegia (4:1 blood:6% hetastarch colloid osmotic pressure 21 +/- 2 mmHg) delivered at 50 mmHg perfusion pressure.


RESULTS
We found that despite increased colloid osmotic pressure, a small but significant increase in myocardial water content still occurred during blood cardioplegia. As myocardial lymph flow virtually ceased during cardioplegia, myocardial microvascular filtration must have been present. However, increased myocardial lymph flow following cardioplegia resulted in complete oedema resolution associated with normal left ventricular performance post-cardiopulmonary bypass.


CONCLUSIONS
Our data show that the plegic myocardium is prone to oedema formation because of both relatively enhanced fluid filtration and lymph flow cessation. We conclude that increasing the colloid osmotic pressure of normothermic blood cardioplegia minimizes myocardial oedema, thus preventing post-cardiopulmonary bypass cardiac dysfunction.
Center for Microvascular and Lymphatic Studies, Department of Anesthesiology, The University of Texas-Houston Medical School, 77030, USA. uwe.mehlhorn@medizin.uni-koeln.de
U
U
Mehlhorn
S J
SJ
Allen
K L
KL
Davis
H J
HJ
Geissler
R D
RD
Warters
E
E
Rainer de Vivie
D000818:Animals; D002315:Cardiopulmonary Bypass; D003102:Colloids; D004285:Dogs; D004489:Edema, Cardiac / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006439:Hemodynamics; D007036:Hypothermia, Induced; D008297:Male; D009997:Osmotic Pressure; D011183:Postoperative Complications / Q000517:prevention & control*; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000517:prevention & control*
D003102:Colloids