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Ann Thorac Surg 1991;51:359-367
© 1991 The Society of Thoracic Surgeons

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Articles

Magnesium ion is beneficial in hypothermic crystalloid cardioplegia

Surgery Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland USA

^_* Address reprint requests to Dr Clark, Department of Surgery, Allegheny General Hospital, 320 North Ave, Pittsburgh, PA 15212.

The role of magnesium ion and its relation to the calcium concentration of cardioplegic solutions was reexamined in this study. Isolated rat hearts were used with an oxygenated modified Krebs-Henseleit bicarbonate buffer as perfusion medium. The hearts were arrested for 20 minutes at 37 °C or 90 minutes at 24 °C. Treatment groups received one dose of nine possible cardioplegic solutions containing magnesium (0, 1.2, or 15 mmol/L) and calcium (0.05, 1.5, or 4.5 mmol/L). Ninety-six percent of the 75 magnesium-treated hearts recovered, regardless of the calcium concentration, in contrast to a 52% recovery rate in the 69 hearts that did not receive magnesium. The addition of 15 mmol/L Mg²⁺ to a cardioplegic solution containing no magnesium but 0.05 mmol/L Ca²⁺ significantly increased (p < 0.01) the percent recovery of the following parameters of cardiac function: systolic pressure, 74% to 93% (37 °C), 64% to 98% (24 °C); cardiac output, 76% to 101% (37 °C), 71% to 102% (24 °C); stroke work, 64% to 104% (37 °C), 52% to 99% (24 °C); and adenosine triphosphate level, 75% to 83% (37 °C), 58% to 90% (24 °C). There were significant reductions (p < 0.03) in percent recovery (37 °C and 24 °C) of cardiac output, stroke work, and adenosine triphosphate level in the groups that contained 0 or 15 mmol/L Mg²⁺ as the calcium concentration was increased from 0.05 to 4.5 mmol/L. Significant progressive augmentation of ventricular recovery and decreased overall mortality is produced at 37 ° and 24 °C with cardioplegia containing high levels of magnesium and low levels of calcium. These data demonstrate the importance of the [equation] relation in an oxygenated crystalloid solution with a pH of 7.45, carbon dioxide tension of 40 mm Hg, and oxygen tension of 750 mm Hg containing 142 mmol/L Na⁺.

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