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Ann Thorac Surg 2001;71:872-876
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Proper timing of blood cardioplegia in infant lambs: superiority of a multiple-dose regimen

Kenneth G. Warner, MDa, Malachi G. Sheahan, MDa, Sameh M. Arebi, MDa, Anirban Banerjee, MDb, Judith M. Deiss-Shrem, CCPa, Kamal R. Khabbaz, MDa

a Division of Cardiothoracic Surgery, New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
b Division of Pediatric Cardiology, New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA

Accepted for publication October 18, 2000.

Address reprint requests to Dr Warner, Division of Cardiothoracic Surgery, Box 266, New England Medical Center, 750 Washington St, Boston, MA 02111
e-mail: kwarner{at}lifespan.org

Background. In the pediatric and infant age groups, it is unclear whether repeated infusions of blood cardioplegia solution during ischemic arrest are beneficial or detrimental when compared with a single-dose regimen.

Methods. Twenty lambs (aged 6 to 7 weeks) were placed on cardiopulmonary bypass. A miniature glass-tip electrode measured myocardial pH and hydrogen ion concentration, [H+], in the anterior wall. The aorta was clamped for 2 hours. Group S (n = 10) received a single dose of blood cardioplegia solution. Group M (n = 10) received multiple doses of blood cardioplegia solution at 20-minute intervals.

Results. The amount of [H+] generated during the cross-clamp period was greater in group S than in group M (39.2 ± 10.1 nmol/L versus 0.4 ± 1.4 nmol/L, p < 0.008). The percent increase in the time constant, tau, an index of diastolic relaxation, was more prolonged after cardiopulmonary bypass in group S when compared with group M (51.4% ± 2.8% versus 6.4% ± 3.0%, p < 0.0001). Similarly, the percent decrease in end systolic elastance, a measure of systolic contractility, was greater in group S after cardiopulmonary bypass when compared with group M (29.5% ± 1.4% versus 7.3% ± 1.3%, p < 0.0001).

Conclusions. In this infant lamb model, multiple doses of blood cardioplegia solution provided superior metabolic preservation and hemodynamic support after 2 hours of aortic clamping when compared with a single-dose regimen.






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