HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Caputo, M. Articles by Angelini, G.D. Search for Related Content PubMed PubMed Citation Articles by Caputo, M. Articles by Angelini, G.D.

Eur J Cardiothorac Surg 1998;13:559-564
© 1998 Elsevier Science NL

Warm blood hyperkalaemic reperfusion (`hot shot') prevents myocardial substrate derangement in patients undergoing coronary artery bypass surgery

Bristol Heart Institute, University Of Bristol, Bristol Royal Infirmary, Bristol BS2 8HW, UK

Received 24 November 1997; received in revised form 9 February 1998; accepted 16 February 1998.

Corresponding author. Tel.: +44 117 9283145; fax: +44 117 9299737.

Objective: A significant metabolic derangement occurs in the ischaemic-reperfused heart of patients undergoing coronary artery bypass surgery using cold blood cardioplegia. The aim of the present study was to investigate whether this effect could be reversed by complementing cold blood cardioplegia with a short terminal exposure of warm blood hyperkalaemic cardioplegia (`hot shot'). Methods: Thirty-five patients undergoing primary elective coronary revascularisation were randomized to one of two different techniques of myocardial protection. In the cold blood group (n=17) myocardial protection was induced using antegrade hyperkalaemic cold blood cardioplegic solution. In the hot shot group (n=18) this was supplemented with a short exposure to hyperkalaemic warm blood cardioplegia prior to removal of the cross clamp. Intracellular substrates (ATP and amino acids) were measured in left ventricular biopsies collected 5 min after institution of cardiopulmonary bypass, after 30 min of ischaemic arrest and 20 min after reperfusion. Results: Biopsies taken at the end of the period of myocardial ischaemia, when compared to control, did not show any significant change in the intracellular concentration of ATP (from 2.71±0.32 to 2.43±0.37 µmol/ g wet for cold blood group and from 2.6±0.3 to 2.5±0.34 µmol/g wet weight for hot shot group) or total free intracellular amino acids pool (from 33.0±1.4 to 30.0±1.4 µmol/g wet weight for cold blood group and from 34.0±1.4 to 34.5±2.3 µmol/g wet weight for hot shot group). Upon reperfusion, however, there was a significant fall in ATP (23.7±1.6 µmol/ g wet weight amino acids, P<0.05) and in amino acids (1.53±0.24 µmol/g wet weight, P<0.05) in the group receiving only cold blood cardioplegia but not in the hot shot group (2.27±0.27 µmol/g wet weight ATP and 30.5±1.6 µmol/g wet weight amino acids). Conclusions: The data suggest that warm blood hyperkalaemic reperfusion hot shot prevents myocardial metabolic derangement seen during coronary artery surgery.

Key Words: Cold blood cardioplegia • Hot shot • Coronary surgery

This article has been cited by other articles:

				H. Imura, M. Caputo, A. Parry, A. Pawade, G. D. Angelini, and M.-S. Suleiman Age-Dependent and Hypoxia-Related Differences in Myocardial Protection During Pediatric Open Heart Surgery Circulation, March 20, 2001; 103(11): 1551 - 1556. [Abstract] [Full Text] [PDF]