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Ann Thorac Surg 1992;54:1144-1150
© 1992 The Society of Thoracic Surgeons

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Articles

Fluosol cardioplegia results in complete functional recovery: A comparison with blood cardioplegia

Division of Cardiothoracic Surgery, Department of Surgery, The University of California, Los Angeles, California, U.S.A.

Accepted for publication March 31, 1992.

^_* Address reprint requests to Dr Laks, Division of Cardiothoracic Surgery, UCLA Medical Center, CHS 62-182-A, 10833 LeConte Ave, Los Angeles, CA 90024.

Blood cardioplegia is considered by many to be the preferred solution for myocardial protection. Proposed benefits include the ability to deliver oxygen and the ability to maintain metabolic substrate stores. However, the decreased capacity of blood to release oxygen at hypothermic conditions as well as the presence of deleterious leukocytes, platelets, and complement may limit complete functional recovery. Fluosol is an asanguineous solution with the ability to bind and release oxygen linearly at low temperatures. Neonatal piglet hearts (24 to 48 hours old) were excised and supported on an isolated, blood-perfused working heart model. After baseline stroke-work index was determined, hearts were arrested with either normocalcemic blood cardioplegia (group 1, n = 8) or normocalcemic Fluosol Cardioplegia (group 2, n = 8). Cold Cardioplegia was administered at 45 mm Hg every 20 minutes for 2 hours. Hearts were then reperfused with whole blood. Functional recovery, expressed as percent of control stroke-work index, was determined 60 minutes after reperfusion at left atrial pressures of 3, 6, 9, and 12 mm Hg. Functional recovery at 60 minutes was similar between group 1 (95%, 93%, 93%, 88%) and group 2 (100%, 94%, 94%, 95%) at left atrial pressures of 3, 6, 9, and 12 mm Hg, respectively. Mean lactate consumption 5 minutes after reperfusion was significantly greater (p = 0.0001) in group 1 (31.8 ± 6.3 µg · min^–1 · g^–1) than in group 2 (–0.59 ± 0.1 µg · min^–1 · g^–), indicating superior metabolic recovery in the blood cardioplegia hearts. Edema formation, as determined both by water content (group 1, 81.10%; group 2, 81.63%) and by electron microscopy, was not significantly different between groups. Tissue adenosine triphosphate levels 1 hour after reperfusion were also not significantly different. In conclusion, similar to blood cardioplegia, Fluosol results in complete functional recovery after cold ischemic arrest, despite inferior metabolic recovery. Because of the absence of injurious blood elements, Fluosol with added substrate may have a role as a cardioplegic agent when preoperative ischemia or hypoxia exists.

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