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Ann Thorac Surg 1998;65:1077-1082
© 1998 The Society of Thoracic Surgeons

Temporal Relation of ATP-Sensitive Potassium-Channel Activation and Contractility Before Cardioplegia

^a Department of Anesthesia and Perioperative Medicine, Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
^b Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA

Accepted for publication November 25, 1997.

Address reprint requests to Dr Spinale, Division of Cardiothoracic Surgery, Medical University of South Carolina, 171 Ashley Ave, Rm 418 CSB, Charleston, SC 29425-2207

Background. Pharmacologic treatment using potassium-channel openers (PCOs) before cardioplegic arrest has been demonstrated to provide beneficial effects on left ventricular performance with subsequent reperfusion and rewarming. However, the PCO treatment interval necessary to provide protective effects during cardioplegic arrest remains to be defined. The present study was designed to determine the optimum period of PCO treatment that would impart beneficial effects on left ventricular myocyte contractility after simulated cardioplegic arrest.

Methods. Left ventricular porcine myocytes were assigned randomly to three groups: (1) normothermic control = 37°C for 2 hours; (2) cardioplegia = K⁺ (24 mEq/L) at 4°C for 2 hours followed by reperfusion and rewarming; and (3) PCO and cardioplegia = 1 to 15 minutes of treatment with the PCO aprikalim (100 µmol/L) at 37°C followed by hypothermic (4°C) cardioplegic arrest and subsequent rewarming. Myocyte contractility was measured after rewarming by videomicroscopy. A minimum of 50 myocytes were examined at each treatment and time point.

Results. Myocyte velocity of shortening was reduced after cardioplegic arrest and rewarming compared with normothermic controls (63 ± 3 µm/s versus 32 ± 2 µm/s, respectively; p < 0.05). With 3 minutes of PCO treatment, myocyte velocity of shortening was improved after cardioplegic arrest to values similar to those of normothermic controls (56 ± 3 µm/s). Potassium channel opener treatment for less than 3 minutes did not impart a protective effect, and the protective effect was not improved further with more prolonged periods of PCO treatment.

Conclusions. A brief interval of PCO treatment produced beneficial effects on left ventricular myocyte contractile function in a simulated model of cardioplegic arrest and rewarming. These results suggest that a brief period of PCO treatment may provide a strategy for myocardial protection during prolonged cardioplegic arrest in the setting of cardiac operation.