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Eur J Cardiothorac Surg 2000;17:63-70
© 2000 Elsevier Science NL

Myocardial protection with high-dose ß-blockade in acute myocardial ischemia

^a Department of Anesthesiology, University of Texas-Houston Medical School, 6431 Fannin, MSMB 5.020, Houston, TX 77030, USA
^b Department of Veterinary Physiology and Pharmacology, Texas A&M University, College Station, TX, USA
^c Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany

Corresponding author. Tel.: +1-713-500-6200; fax: +1-713-500-6201
e-mail: sallen{at}anes1.med.uth.tmc.edu

Objective: The risk of postoperative cardiac dysfunction is markedly increased by emergency coronary artery bypass grafting in the presence of acute myocardial ischemia. High dose ß-blockade during continuous coronary perfusion has been suggested as an alternative to conventional cardioplegia and this technique has been applied successfully in high risk patients for coronary artery bypass grafting (CABG) surgery. This study compared high dose ß-blockade with esmolol to continuous warm blood cardioplegia in a clinically oriented model of acute left ventricular (LV) ischemia and reperfusion. Methods: Twelve dogs were subjected to 60 min of regional LV ischemia by left anterior descending branch (LAD) ligation. Cardiopulmonary bypass (CPB) and aortic crossclamp were applied after 45 min of ischemia. Thereafter, high dose ß-blockade during continuous coronary perfusion (ESMO, n=6) or antegrade continuous warm blood cardioplegia (WBC, n=6) were maintained for 60 min. Myocardial water content (measured from endomyocardial biopsies using a microgravimetric technique), global LV function (preload recruitable stroke work: PRSW), and regional LV function (echocardiographic wall motion score) were determined at baseline and after weaning from CPB. Results: During aortic crossclamp interstitial edema formation was significantly higher in the WBC group with an average water gain of 2.2±0.49 vs. 0.76±0.12% in the ESMO group. Thereafter, edema resolved in both groups, but myocardial water gain remained significantly higher in the WBC group at 60 and 120 min post CPB (0.98±0.19 and 1.13±0.32% vs. 0.07±0.25 and 0.04±0.08%). Global LV function was significantly higher in the ESMO group at 60 and 120 min post CPB (PRSW 103±6 and 94.7±4.6% of baseline vs. 85.3±4.9 and 74.7±7.6% of baseline). However, regional LV function showed no significant difference between groups. Conclusions: High-dose ß-blockade during continuous coronary perfusion may allow the surgeon to utilize the advantages of warm heart surgery, while avoiding the interstitial edema formation and temporary cardiac dysfunction associated with continuous warm blood cardioplegia. In high risk patients such as patients with unstable angina or after failed PTCA, high-dose ß-blockade may be an applicable alternative to cardioplegic arrest.

Key Words: Myocardial ischemia • Myocardial edema • ß-Blocker • Esmolol • Warm blood cardioplegia • Myocardial contractility

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