Back to Search
Start Over
St Thomas' Hospital polarizing blood cardioplegia improves hemodynamic recovery in a porcine model of cardiopulmonary bypass.
- Source :
-
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2019 Dec; Vol. 158 (6), pp. 1543-1554.e8. Date of Electronic Publication: 2018 Dec 12. - Publication Year :
- 2019
-
Abstract
- Objective: Cardiac surgery demands highly effective cardioprotective regimens. We previously demonstrated improved cardioprotection with "polarized" compared with "depolarized" arrest. This study uses a clinically relevant porcine model of cardiopulmonary bypass to compare the efficacy of blood-based St Thomas' Hospital polarizing cardioplegia (STH-Pol-B) with blood-based St Thomas' Hospital hyperkalemic cardioplegia (STH2-B).<br />Methods: Pigs were monitored and subjected to normothermic cardiopulmonary bypass, cardiac arrest via antegrade cold (4°C) blood cardioplegia (STH2-B, control group: n = 6 or STH-Pol-B, study group: n = 7), and global ischemia (60 minutes) followed by on-pump reperfusion (60 minutes) and subsequent off-pump reperfusion (90 minutes). At termination, tissue samples were taken for analysis of high-energy phosphates, ultrastructure, and microRNAs. The primary endpoint of this study was creatine kinase-muscle/brain release during reperfusion.<br />Results: Creatine kinase-muscle/brain was comparable in both groups. After pigs were weaned from cardiopulmonary bypass, hemodynamic parameters such as mean arterial pressure (P = .007), left ventricular systolic pressure (P < .001), external heart work (P = .012), stroke volume (P = .015), as well as dp/dt <subscript>max</subscript> (P = .027), were improved with polarizing cardioplegia. Wedge pressure was significantly lower in the study group (P < .01). Energy charge was comparable between groups. MicroRNA-708-5p was significantly lower (P = .019) and microRNA-122 expression significantly (P = .046) greater in STH-Pol-B hearts.<br />Conclusions: Polarized cardiac arrest offers similar myocardial protection and enhances functional recovery in a porcine model of cardiopulmonary bypass. Differential expression of microRNAs may indicate possible new ischemia-reperfusion markers. These results confirm the noninferiority and potential of polarized versus depolarized arrest.<br /> (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Animals
Bicarbonates pharmacology
Biomarkers blood
Calcium Chloride pharmacology
Creatine Kinase, MB Form blood
Energy Metabolism drug effects
Female
Magnesium pharmacology
MicroRNAs metabolism
Models, Animal
Myocardium metabolism
Myocardium pathology
Potassium Chloride pharmacology
Recovery of Function
Sodium Chloride pharmacology
Sus scrofa
Time Factors
Cardioplegic Solutions pharmacology
Cardiopulmonary Bypass adverse effects
Circulatory Arrest, Deep Hypothermia Induced adverse effects
Hemodynamics drug effects
Ventricular Function, Left drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 1097-685X
- Volume :
- 158
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 31753163
- Full Text :
- https://doi.org/10.1016/j.jtcvs.2018.11.104