ORIGINAL ARTICLES  CARDIAC SECTION 

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

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.