Myocardial protection of the pressure overload hypertrophied heart in human cardiac surgery by acceleration of anaerobic glycolysis.
BACKGROUND
Because of the decreased tolerance to ischemia and increased reperfusion injury in hypertrophied myocardium, myocardial hypertrophy is a well known risk factor for cardiac surgery. We have previously demonstrated in a left ventricular hypertrophy (LVH) model that a highly buffered cardioplegic solution (HBS) that provided glucose as a substrate and promoted anaerobic glycolysis during ischemia afforded superior myocardial protection when compared to standard formulations. And we reported the superiority of this cardioplegia in human cardiac surgery.


METHODS
In this study, 16 patients with aortic stenosis (AS) and LVH receiving HBS were reviewed and compared to another patient group with AS and LVH who received either cold blood cardioplegia (CBC; n=5) or glucose insulin potassium (GIK; n=6).


RESULTS
Postoperative cardiac index was better in the HBS group than the other two groups with similar or lower catecholamine. CK-MB was lower in HBS group than GIK group, but this was not significant. Only one DC cardioversion was required in the HBS group, whereas 2 DC in the CBC group and total 7 DC in the GIK group.


CONCLUSIONS
We found that histidine buffered cardioplegic solution provided comparable or better pump performance after surgery with relatively lower inotropic requirement, less DC cardioversion and homologous blood requirements for left ventricular hypertrophied heart associated with aortic stenosis.
Takeuchi
K
K
Department of Cardiovascular Surgery, Aomori General Hospital, Japan. takeuchi@cc.hirosaki-u.ac.jp
Akimoto
H
H
Maida
K
K
Munakata
M
M
Fukui
K
K
Daitoku
K
K
Takaya
S
S
Suzuki
S
S
Tabayashi
K
K
Tanaka
S
S
D000368:Aged; D015308:Anaerobic Threshold / Q000187:drug effects* / Q000502:physiology*; D001024:Aortic Valve Stenosis / Q000503:physiopathology* / Q000601:surgery*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology*; D002021:Buffers; D006348:Cardiac Surgical Procedures; D002314:Cardioplegic Solutions / Q000494:pharmacology*; D002316:Cardiotonic Agents / Q000494:pharmacology*; D005260:Female; D005947:Glucose / Q000494:pharmacology; D006019:Glycolysis / Q000187:drug effects* / Q000502:physiology*; D006321:Heart / Q000187:drug effects* / Q000503:physiopathology*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006639:Histidine / Q000494:pharmacology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013997:Time Factors
D002021:Buffers; D002314:Cardioplegic Solutions; D002316:Cardiotonic Agents; D006639:Histidine; D005947:Glucose