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Ann Thorac Surg 1990;49:894-902
© 1990 The Society of Thoracic Surgeons

Articles

Postischemic [Ca2+] repletion improves cardiac performance without altering oxygen demands

Hideo Yokoyama, MD, J.Steve Julian, MD, Jakob Vinten-Johansen, PhD*, William E. Johnston, MD, Tonya D. Smith, BS, D.Scott McGee, BS, A.Robert Cordell, MD

Department of Cardiothoracic Surgery, The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina USA

* Address reprint requests to Dr Vinten-Johansen, Department of Cardiothoracic Surgery, The Bowman Gray School of Medicine, 300 S Hawthorne Rd, Winston-Salem, NC 27103.

The positive inotropism expected with correction of postischemic hypocalcemia might be counterbalanced by potential aggravation of reperfusion injury, in particular by calcium overload. We evaluated she effect of normalizing blood calcium concentration ([Ca2+]) on postischemic left ventricular systolic and diastolic mechanics using oxygen consumption and indices derived from pressure-diameter relations. In 10 open-chest dogs on cardiopulmonary bypass, the hearts underwent 30 minutes of normothermic global ischemia followed by one hour of multidose hypothermic C4 °C), hypocalcemic (0.3 mmol/L) blood cardioplegia. After reperfusion, systemic [Ca2+] had decreased to 70% of control (p = 0.017). The left ventricular inotropic state was significantly depressed from baseline (control) values, but was restored to baseline levels by resumption of normocalcemia after one hour of reperfusion. Chamber stiffness increased by 308% (p = 0.006) after hypocalcemic reperfusion but decreased significantly after [Ca2+] correction. Recovery of left ventricular performance with [Ca2+] correction did not augment myocardial oxygen consumption from the postischemic uncorrected state (5.0 ± 0.3 mL O2/min/100 g versus 5.3 ± 0.3 mL O2/min/100 g). We conclude that normalizing [Ca2+] after blood cardioplegia improves postischemic left ventricular performance without adversely affecting compliance or oxygen consumption.




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