Re-excitation of the cardioplegic heart. A possible hazard in clinical cardioplegic arrest

The Thoracic and Cardiovascular Surgeon
H WarneckeH G Borst

Abstract

Clinical cardioplegic arrest may coincide with a washout of cardioplegic agents by varying amounts of extracoronary collateral blood flow. This may shorten the duration of electromechanical arrest. Furthermore, even in the absence of electromechanical cardiac activity, washout may influence the cardioprotective properties of cardioplegic methods. The present study was designed to quantify the effects of cardioplegic washout. In a standardized isolated paracorporeal dog heart model, the St. Thomas's Hospital solution (ST-CP) and the Bretschneider histidine buffered solution (B-CP) were compared under the condition of washout by arterial blood. An inverse relationship was found between the amount of blood flowing through the coronary system and the duration of electromechanical arrest. Flow rates compatible with a 100 min period of complete electromechanical arrest were less than 0.41 ml/100 gr heart weight . min in ST-CP arrest and less than 0.21 ml/100 gr . min in B-CP arrest. This would indicate a greater safety against washout-induced re-excitation in ST-CP arrest. Postarrest myocardial function after 2 hours of complete electromechanical arrest at 20 degrees C was distinctly influenced by washout with arterial blood (20 degr...Continue Reading

Citations

Sep 1, 1984·The Annals of Thoracic Surgery·S F BollingT J Gardner

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