Evaluation of myocardial metabolism with microdialysis after protection with cold blood- or cold crystalloid cardioplegia. A porcine model.

Objectives: There has been a considerable change in the patient population referred for cardiac surgery in the last decade. More complex and marginal patients require optimized myocardial protection. An insufficient cardioplegic procedure results in anaerobic metabolism during cardiac arrest with subsequent lactate accumulation. Increased lactate level is regarded as a predictor for low cardiac output syndrome. In an acute porcine model we examined two standard cardioplegic methods. Myocardial microdialysis was used to investigate the metabolism during cardioplegic arrest and in the reperfusion period.

Methods: Twelve domestic pigs were randomly chosen to receive either cold blood-or cold crystalloid cardioplegia. After midline sternotomy two microdialysis probes were implanted in two different regions of the heart. Cardiopulmonary bypass was initiated, aorta was clamped, and antegrade cardioplegia was delivered. These conditions were maintained for 90 min. Subsequent to myocardial reperfusion the animals were observed for 180 min. Microdialysis and plasma markers to characterize myocardial metabolism, and plasma markers for myocardial failure and necrosis were obtained every 30 min.

Results: Lactate concentrations were significantly increased in the cold crystalloid cardioplegia group compared to the cold blood cardioplegia group, in tissue dialysate (p < 0.001) as well as in serum (p = 0.018). Pyruvate concentrations in the dialysate were significantly increased in the cold crystalloid cardioplegia group compared to the cold blood cardioplegia group (p = 0.008). There were no significant differences in dialysate concentrations of glycerol. Plasma markers for myocardial failure (Brain Natriuretic Peptide) and for myocardial necrosis (Cardiac Troponin T) showed no differences between the groups.

Conclusion: The results indicate that cold blood cardioplegia offers superior protection of the heart, in terms of more rapid normalization of myocardial metabolism. The microdialysis technique seems to have a high sensitivity and ability to detect even minor metabolic changes. This enhances the possibility of designing a myocardial protection, which might lower morbidity and mortality risk.