Mechanoenergetic function and troponin T release following cardioplegic arrest induced by St Thomas' and histidine-tryptophan-ketoglutarate cardioplegia--an experimental comparative study in pigs.
The study compares the single dose histidine-tryptophan-ketoglutarate (HTK) cardioplegia to the repeatedly delivered St Thomas' Hospital Solution (STHS) with respect to preservation of left ventricular mechanoenergetics and leakage of troponin T in a porcine experimental model. Fourteen pigs were randomized to a single infusion of 30 ml/kg HTK cardioplegia (n=7) or 500 ml STHS (n=7) followed by 200 ml after 20 and 40 min. After 1 h of aortic cross-clamping on cardiopulmonary bypass (CPB), the pigs were weaned and the hearts reperfused for 4 h. Stroke work (SW) was determined by a conductance catheter in the left ventricle. Myocardial oxygen consumption (MvO(2)) was measured as a function of coronary blood flow and arterial-to-coronary sinus oxygen saturation difference. Troponin T was sampled from the coronary sinus. The slope of the SW-MvO(2) relationship increased by 1.09 (+/-0.53) in the HTK group compared with 0.33 (+/-0.70) in the STHS group following ischemia and 4 h of reperfusion (P=0.04). Troponin T was significantly higher in the HTK group compared with the STHS group (P=0.04). Repeatedly delivered STHS gives better preservation of postischemic mechanoenergetic function and lower troponin T release compared with single dose HTK cardioplegia, indicating improved cardioprotection with STHS.
Aarsaether
Erling
E
Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, N-9038 Tromsø, Norway. erling.johan.aarsaether@unn.no
Stenberg
Thor Allan
TA
Jakobsen
Øyvind
Ø
Busund
Rolf
R
D000818:Animals; D001639:Bicarbonates / Q000008:administration & dosage / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D002122:Calcium Chloride / Q000008:administration & dosage / Q000009:adverse effects; D002314:Cardioplegic Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D002315:Cardiopulmonary Bypass; D003326:Coronary Circulation; D004195:Disease Models, Animal; D004734:Energy Metabolism / Q000187:drug effects*; D005947:Glucose / Q000008:administration & dosage / Q000009:adverse effects; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods*; D008274:Magnesium / Q000008:administration & dosage / Q000009:adverse effects; D008353:Mannitol / Q000008:administration & dosage / Q000009:adverse effects; D009200:Myocardial Contraction; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control*; D009206:Myocardium / Q000378:metabolism*; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D011189:Potassium Chloride / Q000008:administration & dosage / Q000009:adverse effects; D011343:Procaine / Q000008:administration & dosage / Q000009:adverse effects; D012965:Sodium Chloride / Q000008:administration & dosage / Q000009:adverse effects; D034421:Sus scrofa; D013997:Time Factors; D020107:Troponin T / Q000097:blood*; D016277:Ventricular Function, Left
D001639:Bicarbonates; D015415:Biomarkers; C039984:Bretschneider cardioplegic solution; D002314:Cardioplegic Solutions; C041711:St. Thomas' Hospital cardioplegic solution; D020107:Troponin T; D008353:Mannitol; D012965:Sodium Chloride; D011343:Procaine; D011189:Potassium Chloride; D008274:Magnesium; D005947:Glucose; D002122:Calcium Chloride; D010100:Oxygen