Blood cardioplegic protection in profoundly damaged hearts: role of Na+-H+ exchange inhibition during pretreatment or during controlled reperfusion supplementation.
BACKGROUND
Inhibition of the Na+/H+ exchanger before ischemia protects against ischemia-reperfusion injury, but use as pretreatment before blood cardioplegic protection or as a supplement to controlled blood cardioplegic reperfusion was not previously tested in jeopardized hearts.


METHODS
Control studies tested the safety of glutamate-aspartate-enriched blood cardioplegic solution in 4 Yorkshire-Duroc pigs undergoing 30 minutes of aortic clamping without prior unprotected ischemia. Twenty-four pigs underwent 30 minutes of unprotected normothermic global ischemia to create a jeopardized heart. Six of these hearts received normal blood reperfusion, and the other 18 jeopardized hearts underwent 30 more minutes of aortic clamping with cardioplegic protection. In 12 of these, the Na+/H+ exchanger inhibitor cariporide was used as intravenous pretreatment (n = 6) or added to the cardioplegic reperfusate (n = 6).


RESULTS
Complete functional, biochemical, and endothelial recovery occurred after 30 minutes of blood cardioplegic arrest without preceding unprotected ischemia. Thirty minutes of normothermic ischemia and normal blood reperfusion produced 33% mortality and severe left ventricular dysfunction in survivors (preload recruitable stroke work, 23% +/- 6% of baseline levels), with raised creatine kinase MB, conjugated dienes, endothelin-1, myeloperoxidase activity, and extensive myocardial edema. Blood cardioplegia was functionally protective, despite adding 30 more minutes of ischemia; there was no mortality, and left ventricular function improved (preload recruitable stroke work, 58% +/- 21%, p < 0.05 versus normal blood reperfusion), but adverse biochemical and endothelial variables did not change. In contrast, Na+/H+ exchanger inhibition as either pretreatment or added during cardioplegic reperfusion improved myocardial recovery (preload recruitable stroke work, 88% +/- 9% and 80% +/- 7%, respectively, p < 0.05 versus without cariporide) and comparably restored injury variables.


CONCLUSIONS
Na+/H+ exchanger blockage as either pretreatment or during blood cardioplegic reperfusion comparably delays functional, biochemical, and endothelial injury in jeopardized hearts.
Castellá
Manuel
M
Department of Surgery, Division of Cardiothoracic Surgery, University of California, Los Angeles, School of Medicine, Los Angeles, California, USA.
Buckberg
Gerald D
GD
Tan
Zhongtuo
Z
D000818:Animals; D001769:Blood; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D019332:Endothelin-1 / Q000097:blood; D006146:Guanidines / Q000494:pharmacology*; D007527:Isoenzymes / Q000097:blood; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D017923:Sodium-Hydrogen Exchangers / Q000037:antagonists & inhibitors*; D013450:Sulfones / Q000494:pharmacology*; D013552:Swine; D016277:Ventricular Function, Left / Q000502:physiology
D002314:Cardioplegic Solutions; D019332:Endothelin-1; D006146:Guanidines; D007527:Isoenzymes; D017923:Sodium-Hydrogen Exchangers; D013450:Sulfones; C093373:cariporide; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form