HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Christo I. Tchervenkov Mackenzie Quantz Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hosseinzadeh, T. Articles by Chiu, R. C.- J. Search for Related Content PubMed PubMed Citation Articles by Hosseinzadeh, T. Articles by Chiu, R. C.- J.

Ann Thorac Surg 1992;53:464-471
© 1992 The Society of Thoracic Surgeons

---

Articles

Adverse effect of prearrest hypothermia in immature hearts: Rate versus duration of cooling

Division of Cardiovascular Surgery, The Montreal General Hospital/McGill University, Montreal, Quebec, Canada

Accepted for publication August 29, 1991.

^_* Address reprint requests to Dr Tchervenkov, Cardiovascular Surgery, The Montreal Children's Hospital, 2300 Tupper St, Montreal, Que, Canada, H3H 1P3.

It has been suggested that rapid cooling before the induction of arrest may be harmful to the newborn myocardium. The objective of this study was twofold: (1) to evaluate whether preancst rapid cooling is indeed detrimental to myocardial recovery and (2) if so, to evaluate whether the adverse effect of prearrest hypothermia is dependent on the rate of cooling or the total duration of cold perfusion. After an initial stabilization period isolated Langendorff hearts (n = 5 per group) from neonatal piglets (5 to 7 days old) were randomized to four groups: group 1, 5 minutes of rapid cooling to 15 °C; group 2, 20 minutes of slow cooling to 15 °C; group 3 and group 4, rapid and slow cooling, respectively, with the addition of St. Thomas cardioplegic solution. All groups were then subjected to 2 hours of ischemia at 15 °C followed by 30 minutes of reperfusion at 38.5 °C. Postischemic recovery of left ventricular developed pressure was significantly greater in group 1 versus group 2 (80% ± 3% versus 61% ± 2%; p < 0.05) and in the presence of cardioplegia, group 3 versus group 4 (72% ± 3% versus 57% ± 3%; p < 0.05). The increase in left ventricular end-diastolic pressure was significantly less in group 1 versus group 2 (8% ± 5% versus 33% ± 7%; p < 0.01). Myocardial adenosinotriphosphate content recovery correlated with ventricular recovery. To evaluate the second objective, hearts were divided into three groups: group 1, rapid cooling (5 minutes); group 2, rapid cooling (5 minutes) + cold perfusion (15 minutes) at 15 °C; and group 3, slow cooling (20 minutes). Postischemic recovery of left ventricular developed pressure was significantly greater in group 1 versus groups 2 or 3 (80% ± 3% versus 64% ± 5% or 61% ± 2%, respectively; p < 0.05). Rise in left ventricular end-diastolic pressure was significantly less in group 1 (8% ± 5%) versus group 2 (43% ±14%) or group 3 (33% ± 7%) (p < 0.05). Creatine phosphate levels correlated directly with greater recovery of ventricular function in group 1. The results demonstrate that (1) rapid cooling is not detrimental and in fact offers better protection than slow cooling, (2) the detrimental effect of cooling appears to be related to the duration and not the rate of cooling, and (3) cardioplegia does not provide any additional protection. Therefore, prolonged prearrest hypothermic perfusion is detrimental to the newborn heart and should be avoided.

This article has been cited by other articles:

				C. Drescher, A. Diestel, S. Wollersheim, F. Berger, and K. R. L. Schmitt How does hypothermia protect cardiomyocytes during cardioplegic ischemia? Eur J Cardiothorac Surg, August 1, 2011; 40(2): 352 - 359. [Abstract] [Full Text] [PDF]

				T. Doenst, C. Schlensak, and F. Beyersdorf Cardioplegia in pediatric cardiac surgery: do we believe in magic? Ann. Thorac. Surg., May 1, 2003; 75(5): 1668 - 1677. [Abstract] [Full Text] [PDF]

				S. M. Torrance and C. Wittnich Postischemic functional recovery in immature hearts is influenced by performance index and assessment technique Am J Physiol Heart Circ Physiol, December 1, 2001; 281(6): H2446 - H2455. [Abstract] [Full Text] [PDF]

				M. Karck, P. A. Schnabel, A. Kilkowski, S. Schulte, and A. Haverich Adverse Effects of Crystalloid Cardioplegia and Slow Cooling for Protection of Immature Rat Hearts Ann. Thorac. Surg., September 1, 1996; 62(3): 702 - 709. [Abstract] [Full Text]

				H. Velvis, M. H. Hines, H. S. Klopfenstein, D. D. Berry, and J. Vinten-Johansen DEPRESSION OF CARDIAC FUNCTION AFTER DEEP HYPOTHERMIC CIRCULATORY ARREST IN DEEPLY ANESTHETIZED NEONATAL LAMBS J. Thorac. Cardiovasc. Surg., February 1, 1996; 111(2): 359 - 366. [Abstract] [Full Text]

				M. Karck, G. Ziemer, M. Zoeller, S. Schulte, K.-D. Juergens, H. Weisser, and A. Haverich Protection of the chronic hypoxic immature rat heart during global ischemia Ann. Thorac. Surg., March 1, 1995; 59(3): 699 - 706. [Abstract] [PDF]

				D. Shum-Tim, C. I. Tchervenkov, J. O. Lough, and R. C.- J. Chiu Newborn myocardial protection after prolonged prearrest cooling: A calcium overload phenomenon? Ann. Thorac. Surg., February 1, 1994; 57(2): 311 - 318. [Abstract] [PDF]

				J. S. Heinle, A. J. Lodge, J. R. Mault, E. G. Whitaker, and R. M. Ungerleider Myocardial function is normal after rapid cooling of the in vivo neonatal heart Ann. Thorac. Surg., February 1, 1994; 57(2): 326 - 332. [Abstract] [PDF]

				I. M. Rebeyka and W. G. Williams Invited commentary Ann. Thorac. Surg., February 1, 1994; 57(2): 332 - 333. [PDF]