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Ann Thorac Surg 1979;28:281-289
© 1979 The Society of Thoracic Surgeons

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Articles

The Importance of Hyperkalemia in a Cold Perfusion Solution: A Correlative Study Examining Myocardial Function, Metabolism, Tissue Gases, and Substrates

From the Thoracic Surgery Service, Department of Surgery, Letterman Army Medical Center, and Department of Surgery, Letterman Army Institute of Research, Presidio of San Francisco, CA.

Twenty-four pigs were studied to assess the effect of potassium in a cardioplegic solution on the ability of the swine myocardium to maintain functional and metabolic integrity following induced ischemia. The pigs were evaluated on total and right heart bypass with measurement at normothermia and after a one-hour intervention of stroke volume (SV), coronary blood flow (CBF), myocardial oxygen consumption (MV_o2), and lactate extraction. Myocardial tissue gases (PmO₂ and PmCO₂) were continuously monitored and, at the conclusion of the procedure tissues were analyzed for adenosine triphosphate (ATP). There were five interventions: (1) hypothermic perfusion (28°C) (Group 1); (2) hypothermic ischemia (28°C) (Group 2); and hypothermic ischemia with a cardioplegic solution (nonlactated Ringer's solution, pH 7.4, 4°C) using (3) normokalemia (4 mEq of potassium chloride/L, 300 mOsm/L) (Group 3), (4) hyperkalemia (43 mEq of KC1/L, 390 mOsm/L) (Group 4), and (5) normokalemia with increased osmolality (3.6 mEq of KC1/L, 400 mOsm/L) (Groups 5). A significant decrease in SV and elevation in peak PmCO₂ were seen in all groups subjected to ischemia except those protected with hyperkalemic solution.

We conclude that the presence of hyperkalemia in a cold root perfusion solution provides better myocardial protection than cold root perfusion alone. Furthermore, potassium arrest appears to be more protective than coronary perfusion at 28°C.

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