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Ann Thorac Surg 1993;55:933-939
© 1993 The Society of Thoracic Surgeons

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Articles

Systolic and diastolic function of both ventricles after prolonged cardioplegic arrest

National Heart and Lung Institute, London, and Harerfield Hospital, Harefield, Middlesex, United Kingdom

Accepted for publication July 22, 1992.

^_* Address reprint requests to Mr Mankad, Department of Cardiothoradc Surgery, The Hospital for Sick Children, Great Ormond St, London WC1N 3JH, United Kingdom.

The current technique of donor heart preservation for transplantation is known to cause myocardial dysfunction. We have investigated the effect of 2, 4, and 8 hours of glotal ischemia at 4 °C with a single infusion of St. Thomas' Hospital cardioplegic solution on the recovery of right and left ventricular function in the bloodperfused, isolated pig heart. Two hours of ischemia caused significant deterioration in both left (p < 0.05) and right (p < 0.01) ventricular diastolic function as assessed by ventricular compliance and stiffness (reduction in left and right ventricular compliances, 19.3% ± 14.8% and 13.3% ± 3.5%, respectively) but had no significant effect on systolic function as evaluated by the slope value of the systolic pressure-volume relationship (peak elastance). Four hours of ischemia resulted in further reduction in ventricular compliance (left ventricle, p < 0.001; right ventricle, p < 0.05) and also caused left ventricular systolic dysfunction (p < 0.05). Eight hours of ischemia caused approximately 50% reduction in left ventricular (p < 0.01) and right ventricular (p < 0.05) compliance and left ventricular elasiance (p < 0.001). Coronary vascular resistance at the end of 2 hours of reperfusion after preservation was significantly elevated as compared with the control value in all three groups. There was no correlation between the percentage increase in coronary vascular resistance and the percent age reduction in left or right ventricular diastolic function. We conclude that in the pig heart preserved ex vivo at 4 °C, right and left ventricular diastolic dysfunction occurs before systolic dysfunction and this is not related to gain in heart weight or to increase in coronary vascular resistance observed after reperfusion.

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