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Ann Thorac Surg 1981;32:75-79
© 1981 The Society of Thoracic Surgeons

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Articles

The Optimal Potassium Concentration in Cardioplegic Solutions

From the Departments of Surgery, the University of Connecticut, Farmington, CT, the Baystate Medical Center, Springfield, and the Department of Public Health, the University of Massachusetts, Amherst, MA

Accepted for publication January 20, 1981.

^* Address reprint requests to Dr. Rousou, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01107

High-energy phosphates provide a sensitive index of myocardial preservation. This experiment was designed to use this index in order to assess the efficacy of various potassium concentrations in a crystalloid cardioplegic solution in protecting the myocardium during hypothermic ischemic arrest. The in vivo ischemic pig-heart model was used, measuring left ventricular levels of adenosine triphosphate (ATP) before, during, and after a two-hour arrest period and after 30 minutes of reperfusion. Thirty-eight animals were divided into seven groups of 5 to 6 animals each. Each group received a different potassium concentration in the cardioplegic solution, namely 5, 10, 15, 20, 25, 30, and 35 mEq/L. The results were as follows: the ATP moiety was best preserved during ischemia and reperfusion in the 15 mEq/L group, while it remained significantly lower in the 5 mEq/L group. The 10, 20, 25, 30, and 35 mEq/L groups showed an intermediate range of ATP preservation. We conclude from these results that cardioplegic solutions containing 5 mEq/L of potassium seem to be inadequate for myocardial preservation during ischemic arrest; that solutions with 15 mEq/L of potassium may offer the best myocardial protection of all concentrations tested; and that solutions with potassium concentrations of 15 to 35 mEq/L are significantly better than normokalemic (5 mEq/L) cardioplegic solutions.