Abstract |
This study tests the hypothesis that improved muscle salvage after prolonged ischemia (4 hours) occurs when the substrate-enriched blood cardioplegic solution is markedly hyperglycemic (greater than 400 mg/dl) and markedly hyperosmotic (greater than 400 mOsm). Thirty-five dogs underwent 4 hours of occlusion of the left anterior descending coronary artery and reperfusion during total vented bypass with substrate-enriched blood cardioplegic solution, in which the glucose concentration and osmolarity were varied in relation to one another. Spontaneous systolic shortening recovered consistently (31 +/- 6%) only when glucose was greater than 400 mg/dl and osmolarity was greater than 400 mOsm. The least recovery occurred (only one of six dogs recovering spontaneous shortening) when cardioplegic glucose was greater than 400 mg/dl and osmolarity was greater than 400 mOsm. Regional segments reperfused with our standard substrate-enriched blood cardioplegic solution had lower transmural flow rates following reperfusion (56 versus 87 ml/100 gm/min, p less than 0.05), markedly reduced mitochondrial State 3 and State 4 respiration in epicardial and endocardial muscle (p less than 0.05), and the most extensive histochemical evidence of damage (63% area of nonstaining versus area at risk, p less than 0.05). We conclude that markedly increased levels of osmolarity (greater than 400 mOsm) and glucose (greater than 400 mg/dl) improve the capacity of substrate-enriched blood cardioplegic solution to salvage myocardium after prolonged ischemia.
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Authors | F Okamoto, B S Allen, G D Buckberg, H Young, H Bugyi, J Leaf |
Journal | The Journal of thoracic and cardiovascular surgery
(J Thorac Cardiovasc Surg)
Vol. 92
Issue 3 Pt 2
Pg. 583-93
(Sep 1986)
ISSN: 0022-5223 [Print] United States |
PMID | 3747586
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
- Citrates
- Coenzymes
- Glutamates
- Phosphates
- Tromethamine
- Ubiquinone
- Citric Acid
- Aspartic Acid
- Diltiazem
- coenzyme Q10
- Glucose
- Potassium
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Topics |
- Animals
- Aspartic Acid
(therapeutic use)
- Citrates
(therapeutic use)
- Citric Acid
- Coenzymes
- Coronary Circulation
- Coronary Disease
(drug therapy, physiopathology)
- Diltiazem
(therapeutic use)
- Dogs
- Glucose
(pharmacology, therapeutic use)
- Glutamates
(therapeutic use)
- Heart Arrest, Induced
- Myocardial Contraction
(drug effects)
- Osmolar Concentration
- Phosphates
(therapeutic use)
- Potassium
(therapeutic use)
- Tromethamine
(therapeutic use)
- Ubiquinone
(analogs & derivatives, therapeutic use)
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