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Ann Thorac Surg 1992;53:1062-1067
© 1992 The Society of Thoracic Surgeons

Articles

Efficacy of isoproterenol on the failing transplanted heart during early acute rejection

Eric De Broux, BSc, Gaétan Lagacé, Claude Chartand, MD*

Service de Chirurgie Cardiovasculaire, Hôpital Ste-Justine, et Université de Montréal, Montréal, Québec, Canada

Accepted for publication December 5, 1991.

* Address reprint requests to Dr Chartrand, Service de Chirurgie Cardiovasculaire, Hôpital Ste-Justine, 3175 Côte Ste-Catherine, Montréal, Québec, Canada H3T 1C5.

Acute rejection often leads to severe myocardial failure and death. The beneficial hemodynamic effects of isoproterenol in improving immediate postoperative heart failure have prompted its routine use after transplantation. However, because of the physiopathological alterations documented during rejection, an inappropriate response of the graft to isoproterenol administration could be expected. Six dogs received orthotopic transplants and were prepared with implantable devices for serial hemodynamic studies. The studies were performed on the resting unanesthetized subject 3 hours after operation when transient heart failure was present and repeated when myocardial failure secondary to rejection occurred. After basal state measurement, various doses of isoproterenol were infused and the hemodynamic responses during each period were compared. During rejection, the hemodynamic response to 0.05 and 0.10 µg · kg–1 · min–1 was significantly lower when compared with the response in the postoperative period. To achieve similar postoperative chronotropic and inotropic effects, 0.35 µg · kg–1 · min–1 of isoproterenol was necessary. Isoproterenol is therefore effective in controlling myocardial failure during acute rejection despite a reduced sensitivity of the sinoatrial node and myocardial tissue.






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Copyright © 1992 by The Society of Thoracic Surgeons.