Pharmacologic Preconditioning for Cardioplegic Arrest

Document Type

Article

Publication Date

12-1-1997

Description

Significant improvement has been achieved in myocardial protection, however, perioperative tissue damage continues to be a frequent contributor of morbidity and mortality after open heart surgery. Ischemic preconditioning has received universal acceptance to protect the heart against ischemic reperfusional injury. Adenosine can induce preconditioning in a variety of experimental models, but the use of this approach in arrested hearts has not been reported. The isolated working rat heart perfusion apparatus was used for this study. Krebs-Henseleit bicarbonate buffer containing 15mM glucose was used as perfusate. Adenosine at 0,0.1. and 1mM was included in the buffer for 5 min before each group of hearts was arrested by potassium cardioplegia at 240C. High dose adenosine produced significant dromotropic effect and only hearts that received low dose adenosine recovered normal rhythm. During reperfusion, significant higher recovery in pressure development (74±15% vs 18±7%) and cardiac output (35±4% vs 19±3%) were found in the pharmacologic preconditioning groups as compared to the 0 adenosine group. The myocardial ATP (73±6% vs 53±6%) and phosphocreatine (67±10% vs 54±7%) also maintained at much higher levels for the preconditioned hearts. Pharmacologic preconditioning may offer a clinical practice to enhance the myocardial protection during elective cardioplegia.

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