Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany.
Hannover Medical School, Institute of Functional and Applied Anatomy, Hannover, Germany.
Eur J Cardiothorac Surg. 2021 Oct 22;60(4):908-917. doi: 10.1093/ejcts/ezab117.
Esmolol-based cardioplegic arrest offers better cardioprotection than crystalloid cardioplegia but has been compared experimentally with blood cardioplegia only once. We investigated the influence of esmolol crystalloid cardioplegia (ECCP), esmolol blood cardioplegia (EBCP) and Calafiore blood cardioplegia (Cala) on cardiac function, metabolism and infarct size in non-infarcted and infarcted isolated rat hearts.
Two studies were performed: (i) the hearts were subjected to a 90-min cardioplegic arrest with ECCP, EBCP or Cala and (ii) a regional myocardial infarction was created 30 min before a 90-min cardioplegic arrest. Left ventricular peak developed pressure (LVpdP), velocity of contractility (dLVP/dtmax), velocity of relaxation over time (dLVP/dtmin), heart rate and coronary flow were recorded. In addition, the metabolic parameters were analysed. The infarct size was determined by planimetry, and the myocardial damage was determined by electron microscopy.
In non-infarcted hearts, cardiac function was better preserved with ECCP than with EBCP or Cala relative to baseline values (LVpdP: 100 ± 28% vs 86 ± 11% vs 57 ± 7%; P = 0.002). Infarcted hearts showed similar haemodynamic recovery for ECCP, EBCP and Cala (LVpdP: 85 ± 46% vs 89 ± 55% vs 56 ± 26%; P = 0.30). The lactate production with EBCP was lower than with ECCP (0.6 ± 0.7 vs 1.4 ± 0.5 μmol/min; P = 0.017). The myocardial infarct size and (ECCP vs EBCP vs Cala: 16 ± 7% vs 15 ± 9% vs 24 ± 13%; P = 0.21) the ultrastructural preservation was similar in all groups.
In non-infarcted rat hearts, esmolol-based cardioplegia, particularly ECCP, offers better myocardial protection than Calafiore. After an acute myocardial infarction, cardioprotection with esmolol-based cardioplegia is similar to that with Calafiore.
依托咪酯心脏停搏液比晶体心脏停搏液提供更好的心脏保护，但仅与血液心脏停搏液进行过一次比较。我们研究了依托咪酯晶体心脏停搏液（ECCP）、依托咪酯血液心脏停搏液（EBCP）和 Calafiore 血液心脏停搏液（Cala）对非梗死和梗死的分离大鼠心脏的心脏功能、代谢和梗死面积的影响。
进行了两项研究：（i）心脏接受 ECCP、EBCP 或 Cala 进行 90 分钟心脏停搏；（ii）在 90 分钟心脏停搏前 30 分钟创建区域性心肌梗死。记录左心室峰值发展压力（LVpdP）、收缩速度（dLVP/dtmax）、舒张速度随时间变化（dLVP/dtmin）、心率和冠状动脉流量。此外，还分析了代谢参数。通过平面测量法确定梗死面积，通过电子显微镜确定心肌损伤。
在非梗死心脏中，ECCP 比 EBCP 或 Cala 更好地保留心脏功能，与基线值相比（LVpdP：100±28%比 86±11%比 57±7%；P=0.002）。梗死心脏中，ECCP、EBCP 和 Cala 的血液动力学恢复相似（LVpdP：85±46%比 89±55%比 56±26%；P=0.30）。EBCP 的乳酸生成低于 ECCP（0.6±0.7 比 1.4±0.5 μmol/min；P=0.017）。各组的心肌梗死面积（ECCP 比 EBCP 比 Cala：16±7%比 15±9%比 24±13%；P=0.21）和超微结构保存均相似。
在非梗死大鼠心脏中，依托咪酯心脏停搏液，特别是 ECCP，提供比 Calafiore 更好的心肌保护。急性心肌梗死后，依托咪酯心脏停搏液的心脏保护作用与 Calafiore 相似。
