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Ann Thorac Surg 1994;58:1645-1650
© 1994 The Society of Thoracic Surgeons

Articles

Decreasing myocardial pH reflects ischemia during continuous warm retrograde cardioplegic arrest

Russell F. Stahl, MD*, Babs R. Soller, PhD, Charles Hsi, MD, Janice Belleisle, BS, Thomas J. Vander Salm, MD

Division of Cardiac and Thoracic Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts USA

Accepted for publication May 23, 1994.

* Address reprint requests to Dr Stahl, Division of Cardiac and Thoracic Surgery, Department of Surgery, University of Massachusetts Medical Center, 55 Lake Ave North, Worcester, MA 01655.

Warm continuous retrograde cardioplegia is thought to prevent myocardial ischemia. We tested this hypothesis by subjecting canine hearts to 2 hours of either antegrade or retrograde perfusion with normothermic blood cardioplegia. Ischemie alterations were evaluated through the measurement of myocardial pH, tissue levels of adenosine triphosphate and lactate, and the preservation of left ventricular contractility. Antegrade perfusion resulted in uniformly positive changes in the myocardial pH in both ventricles, preserved levels of adenosine triphosphate, and small increases in the myocardial lactate levels. In contrast, retrograde perfusion caused the myocardial pH to decrease, especially in the right ventricle. Tissue lactate levels rose to a significantly greater extent during retrograde perfusion and adenosine triphosphate levels declined, although not to a statistically significant degree. Finally, myocardial function, as assessed by the preload recruitable work area, was preserved (103% ± 20% of baseline) in the antegrade group but was markedly diminished (33% ± 6%) in retrogradely perfused left ventricles 35 minutes after the aortic cross-clamp was removed. These data suggest that ischemie metabolism and the subsequent alteration of myocardial function take place despite continuous retrograde perfusion with normothermic blood cardioplegia.




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