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The Journal of Cardiovascular Surgery 2002 February;43(1):37-41

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Myocardial protection of the pressure overload hypertrophied heart in human cardiac surgery by acceleration of anaerobic glycolysis

Takeuchi K. 1, 2, Akimoto H. 1, 3, Maida K. 1, Munakata M. 1, 2, Fukui K. 2, Daitoku K. 2, Takaya S. 2, Suzuki S. 2, Tabayashi K. 3, Tanaka S. 1

From the 1 Department of Cardiovascular Surgery, Aomori General Hospital 2 First Department of Surgery Hirosaki University School of Medicine 3 Department of Thoracic Surgery Tohoku University School of Medicine, Japan


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Back­ground. ­Because of the ­decreased tol­er­ance to ­ischemia and ­increased reper­fu­sion ­injury in hyper­tro­phied myo­car­dium, myo­car­dial hyper­trophy is a ­well ­known ­risk ­factor for car­diac sur­gery. We ­have pre­vi­ously dem­on­strated in a ­left ven­tric­ular hyper­trophy (LVH) ­model ­that a ­highly buf­fered car­di­o­plegic solu­tion (HBS) ­that pro­vided glu­cose as a sub­strate and pro­moted anaer­obic gly­col­ysis ­during ­ischemia ­afforded ­superior myo­car­dial pro­tec­tion ­when com­pared to stan­dard for­mu­la­tions. And we ­reported the super­iority of ­this car­di­o­plegia in ­human car­diac sur­gery.
­Methods. In ­this ­study, 16 ­patients ­with ­aortic sten­osis (AS) and LVH ­receiving HBS ­were ­reviewed and com­pared to ­another ­patient ­group ­with AS and LVH who ­received ­either ­cold ­blood car­di­o­plegia (CBC; n=5) or glu­cose insulin potas­sium (GIK; n=6).
­Results. Post­op­er­a­tive car­diac index was ­better in the HBS ­group ­than the ­other two ­groups ­with sim­ilar or ­lower cat­e­chol­a­mine. CK-MB was ­lower in HBS ­group ­than GIK ­group, but ­this was not sig­nif­i­cant. ­Only one DC car­di­o­ver­sion was ­required in the HBS ­group, ­whereas 2 DC in the CBC ­group and ­total 7 DC in the GIK ­group.
Con­clu­sions. We ­found ­that his­ti­dine buf­fered car­di­o­plegic solu­tion pro­vided com­par­able or ­better ­pump per­for­mance ­after sur­gery ­with rel­a­tively ­lower ­inotropic require­ment, ­less DC car­di­o­ver­sion and homol­o­gous ­blood require­ments for ­left ven­tric­ular hyper­tro­phied ­heart asso­ciated ­with ­aortic sten­osis.

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