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Ann Thorac Surg 1975;20:86-90
© 1975 The Society of Thoracic Surgeons


Articles

Protection of the Myocardium with High-Energy Solutions

Sidney Levitsky, M.D.*,*, Harold Feinberg, Ph.D.

From the Departments of Surgery and Pharmacology, Abraham Lincoln School of Medicine and School of Basic Medical Science, University of Illinois College of Medicine, Chicago, Ill.

* Address reprint requests to Dr. Levitsky, Department of Surgery, Abraham Lincoln School of Medicine of the University of Illinois College of Medicine, P.O. Box 6998, Chicago, Ill. 60680.


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An approach to intraoperative protection of the myocardium is described that attempts to increase glucose utilization by infusion of high-energy solutions during aortic cross-clamping. Infusion of hypertonic glucose or glucose plus insulin prior to aortic cross-clamping has enhanced contractility and increased high-energy phosphate moieties in animals with induced ischemia. Recent pilot experiments in our laboratory suggest that infusions of creatine may result in increased production of creatine phosphate, which in turn induces phosphorylation of adenosine diphosphate to adenosine triphosphate, possibly enhancing myocardial contractility. The intraoperative clinical benefits of these infusions remain to be proved, however.


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Supported by American Heart Association Grant-in-Aid 73-925.

* Established Investigator, American Heart Association.


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  1. Austen WG, Greenberg JJ, Picinini PC. Myocardial function and contractile force protected by glucose loading of the heart during anoxia Surgery 1961;57:839.
  2. Fedelesova M, Ziegelhoffer A, Krause EG, Wollenberger A. Effect of exogenous adenosine triphosphate on the metabolic state of the excised hypothermic dog heart Circ Res 1969;24:617.[Abstract/Free Full Text]
  3. Hewitt RL, Lolley DM, Adrouny GA, Drapanas T. Protective effect of myocardial glycogen on cardiac function during anoxia Surgery 1973;73:444.[Medline]
  4. Hoffman PC, Okita GT. Penetration of ATP into the myocardium Proc Soc Exp Biol Med 1965;119:573.[Abstract/Free Full Text]
  5. Lee YCP, Visscher MB. On the state of creatine in heart muscle Proc Nat Acad Sci 1961;47:1510.[Free Full Text]
  6. Levitsky, S., Feinberg, H., Merchant, F. J., and Nirdlinger, E. L. Increase in Myocardial Creatine Phosphate following Aortic Cross-clamping and Reperfusion. In: J. C. Norman (Ed), Coronary Artery Medicine and Surgery. New York: Appleton-Century-Crofts. Chap 57. (In press.).
  7. Maroko RP, Kjekshus JK, Sobel BE, Watanake T, Canell JW, Ross J, Braunwald E. Factors influencing infarct size following experimental coronary artery occlusion Circulation 1971;43:67.[Abstract/Free Full Text]
  8. Medical Research Council Working party on the Treatment of Myocardial Infarction. Potassium, glucose, and insulin treatment for acute myocardial infarction Lancet 1968;2:1355.[Medline]
  9. Merchant FJ, Feinberg H, Levitsky S. Sequential analysis of altered myocardial metabolism and contractility induced by normothermic arrest and reperfusion J Surg Res 1974;16:153.[Medline]
  10. Scheuer J. Myocardial metabolism in cardiac hypoxia Am J Cardiol 1967;19:385.[Medline]
  11. Weissler AM, Kruger FA, Baba N, Scarpelli DG, Leighton RF, Gallimore JK. Role of anaerobic metabolism in the preservation of functional capacity and structure of anoxic myocardium J Clin Invest 1968;47:403.[Medline]



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