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The Annals of Thoracic Surgery, Vol 36, 132-142, Copyright © 1983 by The Society of Thoracic Surgeons

ARTICLES

Myocardial preservation: effect of venous drainage

EV Bennett Jr, JG Fewel, FL Grover and JK Trinkle

We compared the effect of three methods of venous drainage on myocardial temperature, coronary blood flow as determined with radioactive microspheres, myocardial metabolites (lactate, adenosine triphosphate [ATP], and glycogen), and left ventricular function before, during, and after cardiopulmonary bypass with hypothermic, hyperkalemic cardioplegic arrest. Venous drainage was established in the 6 dogs in Group 1 using a Sarns 51F cavoatrial catheter, in the 7 dogs in Group 2 using two USCI 32F vena caval catheters with tourniquets, and in the 7 dogs in Group 3 using two USCI 32F vena caval catheters without tourniquets. The lowest myocardial temperature was achieved in Group 1 (7.26 degrees +/- 0.45 degrees C compared with 10.45 degrees +/- 0.56 degrees C in Group 2 and 9.78 degrees +/- 0.43 degrees C in Group 3) (p less than 0.001). Myocardial rewarming to 20 degrees C was not significantly different among the groups. Myocardial ATP and lactate levels were similar in all three groups. Myocardial glycogen levels were maintained during ischemia in Group 1 (1,010 +/- 76 mg/dl compared with 686 +/- 39 mg/dl in Group 2) (p less than 0.005). Myocardial blood flow was similar in all groups during the preischemic periods, but during reperfusion a markedly decreased flow was seen in all areas of the myocardium in Group 1 compared with Group 2 (p less than 0.004). Left ventricular function, as measured by the maximum rate of rise of left ventricular pressure, stroke work, and pressure/volume curves, was similar in all groups. We interpret the postischemic blood flow data, glycogen levels, and ventricular compliance differences to suggest that the dogs in Group 1 had less ischemia.

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