Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Science, University of Bergen, Bergen, Norway.
Eur J Cardiothorac Surg. 2017 Jul 1;52(1):180-188. doi: 10.1093/ejcts/ezx035.
This study investigated whether the novel St. Thomas' Hospital polarizing cardioplegic solution (STH-POL) with esmolol/adenosine/magnesium offers improved myocardial protection by reducing demands for high-energy phosphates during cardiac arrest compared to the depolarizing St. Thomas' Hospital cardioplegic solution No 2 (STH-2).
Twenty anaesthetised pigs on tepid cardiopulmonary bypass were randomized to cardiac arrest for 60 min with antegrade freshly mixed, repeated, cold, oxygenated STH-POL or STH-2 blood cardioplegia every 20 min. Haemodynamic variables were continuously recorded. Left ventricular biopsies, snap-frozen in liquid nitrogen or fixed in glutaraldehyde, were obtained at Baseline, 58 min after cross-clamp and 20 and 180 min after weaning from bypass. Adenine nucleotides were evaluated by high-performance liquid chromatography, myocardial ultrastructure with morphometry.
With STH-POL myocardial creatine phosphate was increased compared to STH-2 at 58 min of cross-clamp [59.9 ± 6.4 (SEM) vs 44.5 ± 7.4 nmol/mg protein; P < 0.025], and at 20 min after reperfusion (61.0 ± 6.7 vs 49.0 ± 5.5 nmol/mg protein; P < 0.05), ATP levels were increased at 20 min of reperfusion with STH-POL (35.4 ± 1.1 vs 32.4 ± 1.2 nmol/mg protein; P < 0.05). Mitochondrial surface-to-volume ratio was decreased with polarizing compared to depolarizing cardioplegia 20 min after reperfusion (6.74 ± 0.14 vs 7.46 ± 0.13 µm 2 /µm 3 ; P = 0.047). None of these differences were present at 180 min of reperfusion. From 150 min of reperfusion and onwards, cardiac index was increased with STH-POL; 4.8 ± 0.2 compared to 4.0 ± 0.2 l/min/m 2 ( P = 0.011) for STH-2 at 180 min.
Polarizing STH-POL cardioplegia improved energy status compared to standard STH-2 depolarizing blood cardioplegia during cardioplegic arrest and early after reperfusion.
本研究旨在探讨新型圣托马斯医院极化心脏停搏液（STH-POL）与艾司洛尔/腺嘌呤/镁是否通过减少心脏停搏期间高能磷酸化合物的需求来提供更好的心肌保护，与去极化圣托马斯医院心脏停搏液 2 号（STH-2）相比。
20 只在低温心肺转流下麻醉的猪随机分为心脏停搏 60 分钟，使用新鲜混合、重复、冷、氧合的 STH-POL 或 STH-2 血心脏停搏液进行顺行每 20 分钟一次。连续记录血流动力学变量。在基线、夹闭后 58 分钟、再灌注后 20 分钟和 180 分钟时，通过高效液相色谱法评估左心室活检中的腺嘌呤核苷酸，并用形态计量法评估心肌超微结构。
与 STH-2 相比，在夹闭 58 分钟时，STH-POL 使心肌肌酸磷酸增加[59.9±6.4（SEM）比 44.5±7.4 nmol/mg 蛋白；P<0.025]，在再灌注 20 分钟时，心肌三磷酸腺苷增加[61.0±6.7 比 49.0±5.5 nmol/mg 蛋白；P<0.05]。与去极化心脏停搏液相比，极化 STH-POL 在再灌注 20 分钟时使三磷酸腺苷水平增加（35.4±1.1 比 32.4±1.2 nmol/mg 蛋白；P<0.05）。与极化心脏停搏液相比，再灌注 20 分钟时，线粒体表面积与体积比降低[6.74±0.14 比 7.46±0.13 µm2/µm3；P=0.047]。这些差异在再灌注 180 分钟时均不存在。再灌注 150 分钟后，STH-POL 使心指数增加；STH-POL 为 4.8±0.2 比 STH-2 为 4.0±0.2 l/min/m2（P=0.011）。
与标准的 STH-2 去极化血心脏停搏液相比，极化 STH-POL 心脏停搏液在心脏停搏和再灌注早期改善了能量状态。
