Delivery of a nonpotassium modified maintenance solution to enhance myocardial protection in stressed neonatal hearts: A new approach Michael T. Kronon,

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Presentation transcript:

Delivery of a nonpotassium modified maintenance solution to enhance myocardial protection in stressed neonatal hearts: A new approach Michael T. Kronon, MD*, Bradley S. Allen, MD, Ari Halldorsson, MD, Shaikh Rahman, PhD, Mary Jane Barth, MD, Michel Ilbawi, MD The Journal of Thoracic and Cardiovascular Surgery Volume 123, Issue 1, Pages 119-129 (January 2002) DOI: 10.1053/jtc.2002.v123.p0119 Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 Postbypass left ventricular contractile function after 70-minute cardioplegic arrest. Recovery of left ventricular systolic function as measured by end-systolic elastance (EES) and expressed as percentage of control (baseline). Exposing the heart to hypoxia and ischemia produced such severe stress that warm induction blood cardioplegia was only able to partially resuscitate the heart. Intermittent cardioplegia preserved function at these same levels despite addition of 70 minutes of ischemic arrest. In contrast, adding maintenance infusions of unmodified cold blood (standard integrated strategy) further resuscitated the heart and improved contractility. However, this effect was maximized if modified solution was used for the maintenance infusions (modified integrated strategy), resulting in complete return of systolic function. Asterisk indicates P <.001 versus intermittent cardioplegia; double asterisk indicates P <.001 versus all other groups. The Journal of Thoracic and Cardiovascular Surgery 2002 123, 119-129DOI: (10.1053/jtc.2002.v123.p0119) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 Postbypass left ventricular diastolic compliance after 70-minure cardioplegic arrest, as measured by end-diastolic pressure volume relationship and expressed as percentage of stiffness compared with control (baseline). Asterisk indicates P <.001 versus intermittent cardioplegia; double asterisk indicates P <.001 versus all other groups. The Journal of Thoracic and Cardiovascular Surgery 2002 123, 119-129DOI: (10.1053/jtc.2002.v123.p0119) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 Recovery of overall myocardial function as measured by preload recruitable stroke work (PRSW) and expressed as percentage of control (baseline). Asterisk indicates P <.001 versus intermittent cardioplegia; double asterisk indicates P <.001 versus all other groups. The Journal of Thoracic and Cardiovascular Surgery 2002 123, 119-129DOI: (10.1053/jtc.2002.v123.p0119) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 CVR measured during each antegrade cardioplegic infusion. Piglets receiving retrograde delivery of modified solution (group 5) only had CVR measured during warm induction and reperfusion, and these values were not different from those of piglets receiving antegrade infusions (group 4) Solid line depicts CVR in 6 normal (nonstressed) piglets subjected to 70 minutes of cardioplegic arrest with same cardioplegic protocol (warm induction, multidose cold intermittent cardioplegia, and warm reperfusion). This line therefore represents normal CVR with no vascular dysfunction from stress (hypoxic) injury. After hypoxic-ischemic stress, CVR is increased and remains high with intermittent cardioplegia alone, suggesting vascular injury. However, CVR declines toward normal if maintenance infusions are delivered between cardioplegic doses (integrated strategy), and this effect is maximized if modified solution is used for infusions (see text for details). Data points represent mean; error bars represent SE. Single asterisk indicates P <.001 versus all other groups. The Journal of Thoracic and Cardiovascular Surgery 2002 123, 119-129DOI: (10.1053/jtc.2002.v123.p0119) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions