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Ann Thorac Surg 2006;82:172-178
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Myocardial Metabolism is Better Preserved After Blood Cardioplegia in Infants

Kerstin Åmark, MD a , b , * , Håkan Berggren, MD, PhD d , Kerstin Björk, CCP d , Annica Ekroth, CCP d , Rolf Ekroth, MD, PhD d , Krister Nilsson, MD, PhD c , Jan Sunnegårdh, MD, PhD a , b

a Department of Pediatrics, The Queen Silvia Children's Hospital, Göteborg, Sweden
b Department of Pediatric Anesthesia, The Queen Silvia Children's Hospital, Göteborg, Sweden
c Department of Intensive Care, The Queen Silvia Children's Hospital, Göteborg, Sweden
d Department of Metabolic and Cardiovascular Research/Cardiothoracic Surgery, Göteborg University, Göteborg, Sweden

Accepted for publication January 26, 2006.

* Address correspondence to Dr Åmark, Department of Pediatrics/Cardiology, The Queen Silvia Children's Hospital, SE-416 85 Göteborg, Sweden (Email: kerstin.amark{at}vgregion.se).

BACKGROUND: We have previously reported improved hemodynamic function after blood cardioplegia in comparison with crystalloid cardioplegia. Furthermore, lactate was released from the heart after crystalloid cardioplegia but not after blood cardioplegia. The purpose of this study was to determine whether the difference in substrate metabolism between the two cardioplegia methods was restricted to lactate, or whether the difference in metabolic derangement was more extensive.

METHODS: Thirty consecutive infants with complete atrioventricular septal defects were included in this prospective, randomized, controlled study. Arterial and coronary sinus blood concentrations of substrates and amino acids were measured after weaning from bypass.

RESULTS: After crystalloid cardioplegia, there was a myocardial uptake of glutamate (p = 0.003), leucine (p = 0.03), lysine (p = 0.003), and beta-hydroxybutyrate (p = 0.004), whereas lactate was released (p = 0.03). After blood cardioplegia, there was a myocardial uptake of free fatty acids (p = 0.01) but no uptake of amino acids and no release of lactate.

CONCLUSIONS: There are differences in myocardial substrate metabolism between blood cardioplegia and crystalloid cardioplegia, which involve carbohydrates and amino acids. The differences may include lipids but our data in this respect are not conclusive.






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