The Annals of Thoracic Surgery, Vol 21, 386-396, Copyright © 1976 by The Society of Thoracic Surgeons
Prevention of increased hemoglobin-oxygen affinity in open-heart operations with inosine-phosphate-pyruvate solution
S Giannelli Jr, JP McKenna, JM Bordiuk, LD Miller and CR Jerome
In a control group of 32 patients undergoing open-heart operation,
erythrocyte 2,3-diphosphoglycerate (2,3-DPG) declined progressively during
the course of perfusion from a prebypass mean of 17.00 to 11.29 mu M per
gram of hemoglobin at the end of bypass. The decrease was greater than that
attributable merely to dilution of the patients' cells with the
2,3-DPG-deficient donor cells used to prime the pump oxygenator circuit.
Administration of 300 mg of allopurinol, to prevent the conversion of
inosine to uric acid, every 8 hours during the 24 hours prior to operation
in 11 patients did not prevent the 2,3-DPG decrease during heart-lung
bypass: prebypass, 18.31; postbypass, 13.56 mu M/gm Hgb. The mean P50 for
both these groups combined decreased from a prebypass mean of 25.7 to a
postbypass level of 21.9 torr. A solution of 0.1 M inosine, 0.1 M pyruvate,
and 0.066 M phosphate (IPP) in a dosage of 7.5 ml per kologram of body
weight prevented the 2,3-DPG decrease: prebypass, 15.74; postbypass, 14.85.
Administration of 15 ml per kilogram of IPP in 15 patients preserved
2,3-DPG: prebypass, 18.09; postbypass, 18.52. The P50 remained unchanged in
this last group. The method of providing for myocardial oxygen requirements
during bypass was not standardized, and therefore the protective effect of
IPP against ischemic damage in patients undergoing aortic valve replacement
or myocardial revascularization could not be evaluated. No deleterious
effects of IPP were noted.
