Protecting the aged heart during cardiac surgery: Use of del Nido cardioplegia provides superior functional recovery in isolated hearts Arun Govindapillai,

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Presentation transcript:

Protecting the aged heart during cardiac surgery: Use of del Nido cardioplegia provides superior functional recovery in isolated hearts Arun Govindapillai, BSc, Rui Hua, PhD, Robert Rose, PhD, Camille Hancock Friesen, MD, Stacy B. O'Blenes, MD The Journal of Thoracic and Cardiovascular Surgery Volume 146, Issue 4, Pages 940-948 (October 2013) DOI: 10.1016/j.jtcvs.2013.05.032 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Analysis of lidocaine impact on Na+ channel activation and inactivation kinetics. A, Activation (dashed line) and inactivation (solid line) curves were generated in the presence and absence (control) of lidocaine 0.36 mmol/L as found in del Nido cardioplegia. Lidocaine shifts the activation curve to the right and the inactivation curve to the left. B, Magnified view of the area highlighted in panel A. The area under the intersection of the control activation and inactivation curves (solid arrow) represents the Na+ window current. This is minimized in the presence of lidocaine (open arrow). The Journal of Thoracic and Cardiovascular Surgery 2013 146, 940-948DOI: (10.1016/j.jtcvs.2013.05.032) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Analysis of spontaneous activity during cardioplegic arrest and return of first heart beat after reperfusion. A, Representative tracings of spontaneous ECG activity (upper panel), and Ao pressure fluctuation (lower panel) in a heart arrested with standard cardioplegia. B, Bar graph representing the percentage of hearts showing spontaneous activity during arrest with either standard or del Nido cardioplegia. C, Representative ECG tracings from the start of reperfusion in hearts arrested with standard (upper panel) and del Nido cardioplegia (lower panel). D, Bar graph representing the average time to return of the first heart beat after reperfusion in hearts arrested with standard and del Nido cardioplegia. Bars represent the mean ± SEM (n = 8 hearts per group). Ao, Aortic; ECG, electrocardiogram. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 940-948DOI: (10.1016/j.jtcvs.2013.05.032) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Analysis of cardiac function before and after arrest and reperfusion. A, Representative tracings of aortic pressure (upper panels) and aortic flow (lower panels) recorded in working heart mode. Baseline and postreperfusion tracings are shown from hearts arrested with standard (left panels) and del Nido cardioplegia (right panels). B, Graph showing left ventricular developed pressure measured during working heart mode before (baseline) and at several time points after 60 minutes of cardioplegic arrest and 20 minutes of reperfusion for the standard and del Nido cardioplegia groups. C, Graph showing stroke work indexed to dry heart weight measured during working heart mode before and after cardioplegic arrest. Data points represent the mean ± SEM (n = 8 per group up to the 30-minute time point and 7 per group for the 45- and 60-minute time points). *P ≤ .001. The Journal of Thoracic and Cardiovascular Surgery 2013 146, 940-948DOI: (10.1016/j.jtcvs.2013.05.032) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions