Ann Thorac Surg 1988;46:447-454
© 1988 The Society of Thoracic Surgeons
Articles
Coronary and Systemic Vascular Resistance during Reperfusion after Global Myocardial Ischemia
Stanley B. Digerness, Ph.D.,
John W. Kirklin, M.D.*,
David C. Naftel, Ph.D.,
Eugene H. Blackstone, M.D.,
James K. Kirklin, M.D.,
Paul N. Samuelson, M.D.
Division of Cardiothoracic Surgery, Department of Surgery, and the Department of Anesthesiology, University of Alabama at Birmingham Medical Center, Birmingham, AL
Accepted for publication May 18, 1988.
* Address reprint requests to Dr. John Kirklin, Department of Surgery, University of Alabama at Birmingham, University Station, Birmingham, AL 35294
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Abstract
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During controlled aortic root reperfusion after global myocardial ischemia for the performance of coronary artery bypass grafting (N = 16), coronary blood flow was the highest during the first 1 minute to 2 minutes even though the aortic root pressure was controlled at about 40 mm Hg. Even during the period of controlled low pressure, flow began to decline, and the decline continued during the period in which the pressure was controlled at 75 mm Hg. Calculated coronary vascular resistance rose steadily from an initially low value to one well above the normal value for beating hearts. A transient fall in resistance resulted from the administration of a bolus of nitroglycerin into the aortic root. When the initial reperfusate was normokalemic, coronary flow was less and coronary vascular resistance higher during the initial phase of reperfusion.
The systemic arterial pressure and resistance fell during the first 1 minute to 3 minutes of reperfusion and in 25% of patients, remained low. The greater the potassium load delivered during the initially hyperkalemic phase, the longer the interval between the beginning of reperfusion and the resumption of cardiac systole.
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Footnotes
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Supported in part by Grant HL 17667 from the National Heart, Lung, and Blood Institute to the Specialized Center of Research in Ischemic Heart Disease.
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