Artículos de revistas
Use Of (all-blood) Miniplegia Versus Crystalloid Cardioplegia In An Experimental Model Of Acute Myocardial Ischemia
Registro en:
Journal Of Cardiac Surgery. , v. 23, n. 4, p. 361 - 365, 2008.
8860440
10.1111/j.1540-8191.2008.00651.x
2-s2.0-45449083872
Autor
Petrucci O.
Wilson Vieira R.
Roberto Do Carmo M.
Martins De Oliveira P.P.
Antunes N.
Marcolino Braile D.
Institución
Resumen
Purpose: Several methods of myocardial protection have been used. The use of all-blood solutions modified with glutamate and aspartate has increased. Its use in situations of acute ischemia provides improved contractile function, "resuscitating" the previously lesioned muscle. The dilution preconized by literature is around 25% of the hematocrit. The present study evaluates an all-blood cardioplegia solution with tepid 1% dilution, denominated miniplegia. Material and method: Pigs of the Large-White breed were used with an isolated heart and perfused with blood of a support animal. Three groups (n = 7 per group) were designated with the following treatments: Control group (CO), St. Thomas solution (ST), continuous normothermic all-blood solutions (SG). After the stabilization period, systolic pressure (PS), diastolic pressure (PD), developed pressure (PD), stress of the wall, elastance, and passive stiffness were recorded. The hearts were submitted to 30 minutes of regional ischemia with the clamping of the anterior interventricular artery, and subsequently to 90 minutes of global ischemia with the use of the three different treatments during this period. At the beginning of global ischemia, the coronary clamp was removed. The hearts were again reperfused. Upon three minutes into reperfusion the hearts were defibrillated when necessary. Measurements were taken every 30 minutes to 90 minutes into reperfusion. Results: The SG presented a better recovery of the ventricular function in several of the parameters recorded. The ST group was inferior to the SG group, which in turn was superior to the CO group in some of the parameters analyzed. A higher number of defibrillations were needed to reestablish coordinated heart beats in the ST and CO groups. There were no differences related to the percentage of wet weight between the SG and ST groups, and the percentage was higher in the CO group. Conclusion: The use of all-blood miniplegia provided superior protection when compared to global ischemia or crystalloid cardioplegia in acutely ischemic hearts. The model employed is very close to the clinical situation due to the use of blood as a perfusate. © 2008 by Blackwell Futura Publishing, Inc. 23 4 361 365 Follette, D.M., Fey, K., Buckberg, G.D., Reducing postischemic damage by temporary modification of reperfusate calcium, potassium, pH and osmolarity (1981) J Thorac Cardiovasc Surg, 82, pp. 221-238 Rousou, J.A., Engelman, R.M., Breyer, R.H., The effect of temperature and hematocrit level of oxygenated cardioplegic solutions on myocardial preservation (1988) J Thorac Cardiovasc Surg, 95, pp. 625-630 Menasché, P., Blood cardioplegia: Do we still need to dilute? (1996) Ann Thorac Surg, 62, pp. 957-960 Braile, D.M., Ardito, R.V., Zaiantchick, M., Al, E., Cardioplegia sangüínea contínua normotérmica (1989) Rev Bras Cir Cardiovasc, 4, pp. 109-138 Petrucci Jr., O., Oliveira, P.P.M., Carmo, M.R., Al, E., Standardization of na isolated pig heart preparation with parabiotic circulation: Methodological considerations (2003) Braz J Med Biol Res, 36, pp. 649-659 Strömer, H., Cittadini, A., Szymanska, G., Al, E., Validation of different methods to compare isovolumic cardiac function in isolated hearts of varying sizes (1997) Am J Physiol, 272, pp. 501-510 Brooks, W.W., Healey, N.A., Sem, S., Al, E., Oxygen cost of stress development in hypertrophied and failing hearts from the spontaneously hypertensive rat (1993) Hypertension Dallas, 21, pp. 56-64 Mirsky, I., Elastic properties of the myocardium: A quantitative approach with physiological and clinical applications (1979) Handbook of Physiology: The Cardiovascular System., pp. 497-531. , In: American Physiology Society, Bethesda, MD, pp Suga, H., Left ventricular time-varying pressure/volume ratio in systole as na index of myocardial inotropism (1971) Jpn Heart J, 12, pp. 153-160 Li, G., Sullivan, J.A., You, J.M., Al, E., Effect of pressure on myocardial function after 6 hour preservation with blood cardioplegia (1998) Ann Thorac Surg, 65, pp. 115-124 Misare, B.D., Krukenkamp, I.B., Lazer, Z.P., Al, E., Recovery of postischemic contractile function is depressed by antegrade warm continuous blood cardioplegia (1993) J Thorac Cardiovasc Surg, 105, pp. 37-44 Horsley, W.S., Whitlark, J.D., Hall, J.D., Al, E., Revascularization for acute regional infarct: Superior protection with warm blood cardioplegia (1993) Ann Thorac Surg, 56, pp. 1228-1238 Lichtenstein, S.V., Ashe, K.A., El Dalati, H., Al, E., Warm heart surgery (1991) J Thorac Cardiovasc Surg, 101, pp. 269-274 Salerno, T.A., Houck, J.P., Barrozo, C.A.M., Retrograde continuous warm blood cardioplegia: A new concept in myocardial protection (1991) Ann Thorac Surg, 51, pp. 1023-1025 Ko, W., Zelano, J.A., Lazzaro, R., Superiority of the University of Wisconsin solution over simple crystalloid for extended heart preservation. a study of left ventricular pressure-volume relationship (1992) J Thorac Cardiovasc Surg, 103, pp. 980-992 Lefer, A.M., Role of selectins in myocardial ischemia-reperfusion injury (1995) Ann Thorac Surg, 60, pp. 773-777 Starr, J.P., Jia, C., Amirhamzeh, M.M.R., Al, E., Coronary perfusate composition influences diastolic properties, myocardial water content, and histologic characteristics of the rat left ventricule (1999) Ann Thorac Surg, 68, pp. 925-930 Elvenes, O.P., Korvald, C., Myklebust, R., Al, E., Warm retrograde blood cardioplegia saves more ischemic myocardium but may cause a functional impairment compared to cold crystalloid (2002) Eur J Cardio-thorac Surg, 22, pp. 402-409 Baretti, R., Mizuno, A., Buckberg, G.D., Al, E., Continuous antegrade blood cardioplegia: Cold vs. Tepid (2002) Thorac Cardiovasc Surg, 50, pp. 25-30 Velez, D.A., Morris, C.D., Budde, J.M., Al, E., All-blood (miniplegia) versus dilute cardioplegia in experimental surgical revascularization of evolving infarction (2001) Circulation, 104 (1), pp. I296-I302