Fractal or biologically variable delivery of cardioplegic solution prevents diastolic dysfunction after cardiopulmonary bypass M.R. Graham, MDa, R.K.

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Presentation transcript:

Fractal or biologically variable delivery of cardioplegic solution prevents diastolic dysfunction after cardiopulmonary bypass M.R. Graham, MDa, R.K. Warrian, MDb, L.G. Girling, BSca, L. Doiron, CPCb, G.R. Lefevre, MDa, M. Cheang, MMathc, W.A.C. Mutch, MDa The Journal of Thoracic and Cardiovascular Surgery Volume 123, Issue 1, Pages 63-71 (January 2002) DOI: 10.1067/mtc.2002.118277 Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 Cardioplegia pressure waveforms as recorded from the cardioplegia cannula to the data-acquisition system. Data have been normalized to the same mean pressure for BVC and CC to compare pulse pressures between groups. Data from the BVC experiment are shown as thick black lines , and data from the CC experiment are shown as thin black lines. Sampling rate was every 4 ms for each curve. The Journal of Thoracic and Cardiovascular Surgery 2002 123, 63-71DOI: (10.1067/mtc.2002.118277) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 Serum lactate levels over the course of the experiment in both groups at baseline (B/L ; after cannulation but before CPB), at 60 minutes of CPB, and at 15, 30, and 60 minutes after separation from CPB. Lactate levels were significantly greater in group CC compared with those in group BVC at every time period after CPB (P =.008, group-by-time interaction, analysis of variance). The Journal of Thoracic and Cardiovascular Surgery 2002 123, 63-71DOI: (10.1067/mtc.2002.118277) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 Kp versus time period after CPB. Kp was significantly elevated after bypass in group CC (ie, approximately 100% increase in stiffness) In contrast, Kp remained essentially unchanged with BVC (P =.003, group-by-time interaction). The Journal of Thoracic and Cardiovascular Surgery 2002 123, 63-71DOI: (10.1067/mtc.2002.118277) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 Change in arterial lactate concentration from baseline versus change in Kp from baseline for the 2 experimental groups after separation from CPB. A positive correlation is seen between group CC data between the variables (R2 = 0.51, P <.01). No correlation is evident in group BVC (R2 = 0.01, P = not significant). The Journal of Thoracic and Cardiovascular Surgery 2002 123, 63-71DOI: (10.1067/mtc.2002.118277) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 5 Fractal model of cardioplegia administration with BVC. Analysis of the peak pressure, as measured at the cardioplegia cannula site, is shown for 1 experiment in each group. With BVC, a power-law frequency distribution for log probability of SAP variation versus log SAP variation is seen with a slope of -3.0. Power-law curve fit was an R2 value of 0.97. When examined at the same bin size (100 mm Hg2), there is no evidence of fractal behavior with CC. This is shown as CC pooled. The Journal of Thoracic and Cardiovascular Surgery 2002 123, 63-71DOI: (10.1067/mtc.2002.118277) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

Fig. 6 Consequences of fractal or biologically variable delivery of cardioplegic solution with decreasing perfusion pressure. The BVC/CC flow ratio was calculated at 1.0, 0.8, 0.6, and 0.5 fractions of normalized pressure for each of 2 power-law curves (ie, exponent 3.42 and 2.07) on the basis of data from Aldea and colleagues.5 For both exponents, the normalized BVC/CC flow ratio increases with decreasing fraction of normalized pressure; a greater effect is seen with the higher exponent. Thus, as perfusion pressure decreases, flow is better maintained with BVC. This is most evident in regions of high baseline flow. The Journal of Thoracic and Cardiovascular Surgery 2002 123, 63-71DOI: (10.1067/mtc.2002.118277) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions