European Journal of Cardio-Thoracic Surgery, Vol 3, 346-352, Copyright © 1989 by European Association for Cardio-thoracic Surgery
Clinical validation of St. Thomas' Hospital cardioplegic solution No. 2 (Plegisol)
DJ Chambers, A Sakai, MV Braimbridge, S Kosker, G Manzanera, PR Kind, RA Jupp, LD Smith and B Slavin
Cardiovascular Research, Rayne Institute, London, UK.
Recently, the St. Thomas' Hospital cardioplegic solution No. 2 (Plegisol)
has become available commercially in the UK. In a series of patients (n =
28) undergoing open heart surgery for a variety of lesions, a clinical
validation was performed. Preservation of myocardial contractility was
assessed biophysically by quantitative birefringence measurements of
myocardial biopsy samples (full thickness apical left ventricle and right
ventricle) taken (1) prior to ischaemia, (2) at the end of ischaemia and
(3) 10-15 min after reperfusion during cardiopulmonary bypass. In addition,
serum CK-MB values were measured in samples taken throughout the operation
and for 4 days postoperatively. Postoperative ECG traces (taken every 6 h
for 48 h and then daily up to 7 days) were analysed to identify the
occurrence of perioperative infarction. There were no hospital deaths.
Chronotropic support was required in 5 of 28 patients (18%) for transient
heart block. Low cardiac output did not occur postoperatively.
Birefringence measurements in biopsy samples taken at the end of the
ischaemic period (immediately prior to reperfusion) indicated an apparent
left ventricular deterioration in myocardial contractility in 12 of 28
patients (43%) when compared to biopsies sampled prior to the ischaemic
period. However, after 10-15 min of aerobic reperfusion, measurements
indicated that myocardial contractility recovered to almost pre-ischaemic
levels in the majority of patients. Thus, in 22 of 28 patients (79%), left
ventricular deterioration did not occur in post-ischaemic biopsy samples
when compared to the pre-ischaemic biopsies. Similarly, 21 of 28 patients
(75%) had no deterioration of birefringence values in right ventricular
biopsies.(ABSTRACT TRUNCATED AT 250 WORDS)
