Strategies of myocardial protection for operation in chronic model of cyanotic heart disease Ji Zhang, MD, W.R.Eric Jamieson, MD, Heidar Sadeghi, MD,

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Strategies of myocardial protection for operation in chronic model of cyanotic heart disease Ji Zhang, MD, W.R.Eric Jamieson, MD, Heidar Sadeghi, MD, Kris Gillespie, Joanna R Marier, Harry Mickleson, Robert McGibbon The Annals of Thoracic Surgery Volume 66, Issue 5, Pages 1507-1513 (November 1998) DOI: 10.1016/S0003-4975(98)00949-7

Fig 1 (A) End-systolic elastance (Emax) is the slope of line A, which is plotted for the point of end-systole of each cardiac cycle. End-diastole of each cardiac cycle is plotted on line B. The slope and x-intercept of line B are presented as the diastolic function variables. The Emax is generated directly by the Crystal Biotech Dataflow software, and the slope and x-intercept are calculated by Statistical Analysis System software from the transferred data from the Crystal Biotech Dataflow software. (B) Left ventricular stroke work (LVSW) and stroke volume (SV) were plotted by the Crystal Biotech Dataflow software. Left ventricular stroke work was calculated as the loop area, and SV was the volume difference. The Annals of Thoracic Surgery 1998 66, 1507-1513DOI: (10.1016/S0003-4975(98)00949-7)

Fig 2 Oxygen saturation was significantly increased after operation (10 min and 30 min) compared with the preoperative value (100% oxygen with swine under anesthesia) (PRE). There were no significant differences between groups. (Control = no treatment during corrective surgical procedure; LDF = leukocyte-depleting filter group; PAFA = platelet-activating factor antagonist group; Room Air = room air before operation.) The Annals of Thoracic Surgery 1998 66, 1507-1513DOI: (10.1016/S0003-4975(98)00949-7)

Fig 3 Dopamine requirement was significantly greater in the control group than in the other two groups. The numbers in parentheses are swine requiring inotropic support. (LDF = leukocyte-depleting filter group; PAFA = platelet-activating factor antagonist group.) The Annals of Thoracic Surgery 1998 66, 1507-1513DOI: (10.1016/S0003-4975(98)00949-7)

Fig 4 End-systolic elastance (Emax) was slightly decreased postoperatively in control group and was increased in platelet-activating factor antagonist group (PAFA) and leukocyte-depleting filter group (LDF). There were significant differences between the preoperative (PRE) and 10-minute postoperative (10 min) values in the filter group and the 10-minute and 30-minute postoperative (30 min) values in that group and the control group. (ANOVA = analysis of variance.) The Annals of Thoracic Surgery 1998 66, 1507-1513DOI: (10.1016/S0003-4975(98)00949-7)

Fig 5 Representative average curves of end-systolic elastance (Emax) before operation (PRE) and 30 minutes after cardiopulmonary bypass (30 MIN) in control group and leukocyte-depleting filter group (LDF). In the latter group, the curve shifted upward significantly as Emax increased, thus indicating greater ventricular contractility compared with the control group. (ANOVA = analysis of variance.) The Annals of Thoracic Surgery 1998 66, 1507-1513DOI: (10.1016/S0003-4975(98)00949-7)

Fig 6 Stroke volume–preload curves before operation (PRE) and 10 minutes after cardiopulmonary bypass (10 MIN) in control group and leukocyte-depleting filter group (LDF). In the control group, the curve shifted downward and to the right, indicating reduced stroke volume with same preload after operation. In the filter group, the curve shifted upward and to the left postoperatively, indicating increased stroke volume with same preload. The Annals of Thoracic Surgery 1998 66, 1507-1513DOI: (10.1016/S0003-4975(98)00949-7)

Fig 7 Representative left ventricular pressure–volume loops (Emax) and compliance curves before operation (PRE) and 30 minutes after operation (30 MIN POST) for 1 control and 1 animal with leukocyte-depleting filter (LDF). The loops were shifted to the right postoperatively in the control animal and to the left in the LDF animal. The compliance curve was shifted upward and to the right postoperatively in the LDF animal compared with its preoperative location and the control animal’s curve. The Annals of Thoracic Surgery 1998 66, 1507-1513DOI: (10.1016/S0003-4975(98)00949-7)