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Eur J Cardiothorac Surg 2001;20:555-564
© 2001 Elsevier Science NL

Cardiac dysfunction and inefficiency after substrate-enriched warm blood cardioplegia

Department of Thoracic and Cardiovascular Surgery, University Hospital in Tromsø, Tromsø, Norway

Received 12 December 2000; received in revised form 28 April 2001; accepted 4 June 2001.

Corresponding author. Tel.:+47-7762-6000; fax: +47-7762-8298
e-mail: christian.korvald{at}rito.no

Objective: The study assessed the outcome after prolonged warm continuous antegrade blood cardioplegia (WCBC) with substrate enrichment, in terms of mechanical performance and mechanoenergetic efficiency. Methods: WCBC was given for 3 h to three groups of pigs on cardiopulmonary bypass; WCBC alone (n=7), WCBC+glucose and insulin (+GIK, n=7) and WCBC+L-glutamine (+GLN, n=7). Cardiac systolic and diastolic function, pressure–volume area (PVA) and myocardial oxygen consumption (MVO₂) were assessed before, and twice after WCBC using pressure-conductance catheter, coronary flow-probes and O₂-content difference. Results: In the WCBC, +GIK and +GLN groups respectively, the following parameters decreased after WCBC compared to baseline: left ventricular developed pressure by 26, 19 and 25% (P<0.001); dP/dt_max by 36, 37 and 34% (P<0.001); preload recruitable stroke work by 35, 41 and 28% (P<0.001); mechanoenergetic efficiency (PVA/MVO₂) by 44, 41 and 22% (P<0.001). End-diastolic stiffness increased early after WCBC in the WCBC and +GLN groups, while it was unchanged in the +GIK group (P=0.032). Conclusion: Despite continuous aerobic conditions and additional substrates, post-WCBC cardiac contractile function and mechanoenergetic efficiency was severely depressed. The results demonstrate the hazards of sustained normothermic hyperkalemic perfusion.

Key Words: Warm blood cardioplegia • Left ventricle • GIK • Glutamine • Mechanoenergetic efficiency

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