title: Fractal or biologically variable delivery of cardioplegic solution prevents diastolic dysfunction after cardiopulmonary bypass.
abstract: OBJECTIVE
  To determine whether myocardial protection is improved by restoring physiologic variability to the cardioplegia pressure signal during cardiopulmonary bypass, we compared cardiac function in pigs in the first hour after either conventional cold-blood cardioplegia (group CC) or computer-controlled biologically variable pulsatile cardioplegia (group BVC).
  
  
  METHODS
  Invasive monitors and sonomicrometry crystals were placed, and cardiopulmonary bypass was initiated. The aorta was crossclamped, and cold blood cardioplegic solution was infused intermittently through the aortic root with either conventional cardioplegia (n = 8) or biologically variable pulsatile cardioplegia (n = 8; mean pressure, 75 mm Hg for 85 minutes). The crossclamp was released, cardiac function was restored, and separation from cardiopulmonary bypass was completed. With stable temperature and arterial blood gases, hemodynamics and systolic and diastolic indices were compared at 15, 30, and 60 minutes after cardiopulmonary bypass.
  
  
  RESULTS
  Diastolic stiffness doubled from 0.027 +/- 0.016 mm Hg/mm (mean +/- SD) at baseline to 0.055 +/- 0.036 mm Hg/mm (P =.003) at 1 hour after bypass in group CC, associated with increased left ventricular end-diastolic pressure from 9 +/- 2 to 11 +/- 2 mm Hg (P =.001), mean pulmonary artery pressure from 14 +/- 2 to 20 +/- 3 mm Hg (P =.003), and serum lactate levels from 2.0 +/- 0.5 to 5.6 +/- 2.3 mmol/L (P =.008). Systolic function was not affected. In group BVC diastolic stiffness, left ventricular end-diastolic pressure, and pulmonary artery pressure values were not different from control values at any time after bypass, and serum lactate levels were significantly less than with conventional cold blood cardioplegia. Peak pressure variability with biologically variable pulsatile cardioplegia fit a power-law equation (exponent = -3.0; R(2) = 0.97), indicating fractal behavior.
  
  
  CONCLUSIONS
  Diastolic cardiac function is better preserved after cardiopulmonary bypass with biologically variable pulsatile cardioplegia and fractal perfusion. This may be attributed to enhanced microcirculatory perfusion with improved myocardial protection. A model supporting these results is presented.
authors.affiliation: Department of Anesthesia, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: M R
authors.initials: MR
authors.lastname: Graham
authors.forename: R K
authors.initials: RK
authors.lastname: Warrian
authors.forename: L G
authors.initials: LG
authors.lastname: Girling
authors.forename: L
authors.initials: L
authors.lastname: Doiron
authors.forename: G R
authors.initials: GR
authors.lastname: Lefevre
authors.forename: M
authors.initials: M
authors.lastname: Cheang
authors.forename: W A C
authors.initials: WA
authors.lastname: Mutch
mesh_terms: D000818:Animals; D001794:Blood Pressure; D002302:Cardiac Output; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003971:Diastole; D017709:Fractals; D006339:Heart Rate; D019344:Lactic Acid / Q000097:blood; D010100:Oxygen / Q000097:blood; D013552:Swine; D013813:Therapy, Computer-Assisted; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000517:prevention & control*
chemical_list: D002314:Cardioplegic Solutions; D019344:Lactic Acid; D010100:Oxygen