Adenosine and lidocaine: a new concept in nondepolarizing surgical myocardial arrest, protection, and preservation Geoffrey P. Dobson, PhD, Michael W.

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Presentation transcript:

Adenosine and lidocaine: a new concept in nondepolarizing surgical myocardial arrest, protection, and preservation Geoffrey P. Dobson, PhD, Michael W. Jones, BSc The Journal of Thoracic and Cardiovascular Surgery Volume 127, Issue 3, Pages 794-805 (March 2004) DOI: 10.1016/S0022-5223(03)01192-9

Figure 1 A, Experimental protocol for 30-minute, 2-hour, and 4-hour arrest in the rat heart model. B, Surface temperature profile during arrest. After 30-minute equilibration, hearts were arrested with AL cardioplegic solution or St Thomas' Hospital solution and the aorta clamped. Every 18 minutes the clamp was released and cardioplegic solution delivered for 2 minutes and the clamp reapplied (for 30-minute arrest, a 2-minute pulse was delivered at 15 minutes). Cardioplegic solution was delivered via the aorta at a perfusion head of 70 mm Hg and temperature of 37°C. A 2-minute pulse was administered just before the heart was switched from Langendorff arrest to working mode and recovery was monitored for up to 60 minutes. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 794-805DOI: (10.1016/S0022-5223(03)01192-9)

Figure 2 A representative record of time to electromechanical arrest using AL cardioplegic solution and modified St Thomas' Hospital solution No. 2. The average arrest time for AL hearts was 25 ± 2 seconds (n = 23) and St Thomas' Hospital solution hearts 70 ± 5 seconds (n = 24). In the St Thomas' Hospital solution hearts a few beats just before arrest were common in this group (shown here ∼60 seconds), but they were not normally as strong as indicated here. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 794-805DOI: (10.1016/S0022-5223(03)01192-9)

Figure 3 A, CVR during 2- and 4-hour arrest. B, Oxygen consumption during 2- and 4-hour arrest. CVR was calculated during the 2-minute cardioplegia delivery times every 18 minutes (see Figure 1). Values are mean ± SEM and asterisk shows significance between the 2 cardioplegia groups from repeated-measures ANOVA (P < .05). All statistical tests for the 2- and 4-hour AL and St Thomas' Hospital solution arrest protocols were performed separately. For clarity, only the 4-hour arrest data are presented for oxygen consumption and arrest time; no significant differences in the first 2 hours were found between the 2- and 4-hour arrest protocols. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 794-805DOI: (10.1016/S0022-5223(03)01192-9)

Figure 4 Aortic flow (A), systolic pressure (B), and external cardiac work (C) during the reperfusion period after 30-minute, 2-hour, and 4-hour arrest with AL cardioplegic solution and modified St Thomas' Hospital solution no. 2. Aortic flow is expressed as percentage of control at 5 minutes before arrest. Values are mean ± SEM and asterisk shows significance between the 2 cardioplegia groups at different arrest times (P < .05). For St Thomas' Hospital solution hearts, only 50% (4/8) and 14% (1/7) recovered aortic flow after 2- and 4-hour arrest, respectively. The systolic pressures 5 minutes before arrest in the AL and St Thomas' Hospital solution hearts (in parentheses) for the 30-minute, 2-hour, and 4-hour groups were 128 ± 3 mm Hg (124 ± 1.3 mm Hg), 120 ± 2 mm Hg (121 ± 3 mm Hg), and 118 ± 3.5 mm Hg (122 ± 2.4 mm Hg), respectively. The hydraulic work 5 minutes before arrest in the AL and St Thomas' Hospital solution hearts (in parentheses) for the 30-minute, 2-hour, and 4-hour groups were 42 ± 5 J min−1 g−1 dry weight (43 ± 7 J min−1 g−1 dry weight), 41 ± 2 J min−1 g−1 dry weight (38 ± 3 J min−1 g−1 dry weight), and 44 ± 2 J min−1 g−1 dry weight (45 ± 2 J min−1 g−1 dry weight) J min−1 g−1 dry weight, respectively. The Journal of Thoracic and Cardiovascular Surgery 2004 127, 794-805DOI: (10.1016/S0022-5223(03)01192-9)

Figure 5 Percentage of hearts with aortic flow after 0.5, 2, and 4 hours of multidose AL and modified St Thomas' Hospital solution cardioplegia. Shaded areas depict AL-arrested hearts and unshaded areas are St Thomas' Hospital solution hearts. Failure to survive was defined as the inability of the heart to develop aortic flow against an afterload of 100 cm H2O (see text). The Journal of Thoracic and Cardiovascular Surgery 2004 127, 794-805DOI: (10.1016/S0022-5223(03)01192-9)

The Journal of Thoracic and Cardiovascular Surgery 2004 127, 794-805DOI: (10.1016/S0022-5223(03)01192-9)