Pyruvate-enhanced cardioprotection during surgery with cardiopulmonary bypass.
OBJECTIVE
To determine whether pyruvate-fortified cardioplegia solution provides cardioprotection superior to lactate-based cardioplegia solutions in patients undergoing elective coronary revascularization, with specific attention to post-surgical recovery of left ventricular performance as well as biochemical markers of ischemic injury.


METHODS
Prospective, randomized, semi-blinded human trial.


METHODS
Community-based academic medical center.


METHODS
Thirty adult patients undergoing elective coronary artery bypass graft surgery.


METHODS
Patients were randomized to two 4:1 blood cardioplegia solutions, one pyruvate enhanced and the other lactate based. Hemodynamic and laboratory variables were measured in all patients at pre-cross-clamp, post-cross-clamp, and 4, 6, 8, and 12 hours after bypass.


RESULTS
Relative to lactate-based cardioplegia, pyruvate-fortified cardioplegia sharply increased left ventricular stroke work at 4 to 12 hours after bypass (p < 0.001), lowered coronary sinus troponin I and creatine phosphokinase-MB activities 67% (p < 0.001) and 53% (p < 0.01), respectively, and increased coronary sinus hemoglobin O(2) saturation 18% (p < 0.001). Ten patients treated with lactate cardioplegia required beta-adrenergic inotropic support postbypass, but only 4 pyruvate-treated patients required beta-adrenergic support (p = 0.067). Pyruvate cardioplegia shortened postsurgery hospitalization from 6.3 +/- 0.3 to 5.2 +/- 0.1 days (p < 0.002).


CONCLUSIONS
Pyruvate-fortified cardioplegia mitigated myocardial injury during coronary artery bypass surgery and facilitated postsurgical recovery of cardiac performance. Thus, pyruvate-enhanced cardioplegia may provide cardioprotection superior to lactate-based solutions during surgical cardiac arrest.
Olivencia-Yurvati
Albert H
AH
Department of Surgery, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107-2699, USA. ao-yurvati@hsc.unt.edu
Blair
James L
JL
Baig
Mirza
M
Mallet
Robert T
RT
D000368:Aged; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002395:Catecholamines / Q000008:administration & dosage; D001026:Coronary Artery Bypass / Q000379:methods*; D003402:Creatine Kinase / Q000097:blood / Q000187:drug effects; D005260:Female; D006321:Heart / Q000187:drug effects*; D006324:Heart Arrest, Induced / Q000379:methods; D006801:Humans; D019344:Lactic Acid / Q000008:administration & dosage; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000517:prevention & control; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D019289:Pyruvic Acid / Q000627:therapeutic use*; D016896:Treatment Outcome; D019210:Troponin I / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects
D002314:Cardioplegic Solutions; D002316:Cardiotonic Agents; D002395:Catecholamines; D019210:Troponin I; D019344:Lactic Acid; D019289:Pyruvic Acid; D003402:Creatine Kinase; D010100:Oxygen