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Ann Thorac Surg 1983;35:626-632
© 1983 The Society of Thoracic Surgeons

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Articles

Calcium-Channel Blockade as an Adjunct to Heterogeneous Delivery of Cardioplegia

From the Carlyle Frãser Heart Center, Crawford W. Long Memorial Hospital, Emory University School of Medicine, Atlanta, GA

^* Address reprint requests to Dr. Guyton, Cardiothoracic Research Laboratory, Carlyle Fraser Heart Center, Crawford W. Long Memorial Hospital, Atlanta, GA 30365

The clinical situation of heterogeneous cardioplegia was simulated in a canine model by temporary ligation of the circumflex coronary artery during a three-hour interval of cardioplegic arrest. Nifedipine and lidoflazine, administered prior to aortic clamping, were evaluated as adjuncts to cold (2°C) crystalloid cardioplegia. Assessment was made of regional function (sonomicrometer systolic shortening) and of global function by measuring left atrial (LA) pressure at constant cardiac output (CO), aortic pressure, and heart rate, and by measuring stroke work at constant LA pressure, aortic pressure, and heart rate.

Among 14 control dogs, only 7 could achieve a CO of 5 liters per minute following cardioplegic arrest. Left anterior descending coronary arterial systolic shortening recovered to only 86% of prearrest values (p < 0.05), circumflex coronary arterial systolic shortening recovered only 28% (p < 0.01), stroke work recovered 59% (p < 0.01), and LA pressure was 6.7 mm Hg higher (p < 0.01) than prior to cardioplegic arrest. Lidoflazine provided no statistically significant benefit in these animals (N = 4). However, dogs given nifedipine (N = 6) had very little change in left anterior descending coronary arterial systolic shortening (99% recovery), stroke work (93% recovery), and LA pressure ( = 0.4 mm Hg). None of these changes was statistically significant. There was some deterioration in circumflex coronary arterial systolic shortening (56% recovery; p < 0.05). All 6 dogs given nifedipine achieved a CO of 5 L/min following cardioplegic arrest.

Clinical cardioplegia is typically heterogeneous cardioplegia. Calcium-channel blockade appears to be useful in this situation.

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