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Myocardial protection with oxygenated esmolol cardioplegia during prolonged normothermic ischemia in the rat  Ryuzo Bessho, MD, PhD, David J. Chambers,

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Presentation on theme: "Myocardial protection with oxygenated esmolol cardioplegia during prolonged normothermic ischemia in the rat  Ryuzo Bessho, MD, PhD, David J. Chambers,"— Presentation transcript:

1 Myocardial protection with oxygenated esmolol cardioplegia during prolonged normothermic ischemia in the rat  Ryuzo Bessho, MD, PhD, David J. Chambers, PhD  The Journal of Thoracic and Cardiovascular Surgery  Volume 124, Issue 2, Pages (August 2002) DOI: /mtc Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

2 Fig. 1 Experimental perfusion protocols. In all protocols, hearts were perfused with KHB at constant pressure equivalent to 75 mm Hg both before and after ischemia. Study 1A, Hearts were randomly assigned to one of four groups (n = 6 per group): oxy-KHB (i), multidose oxygenated (95% oxygen/5% carbon dioxide) KHB infused for 3 minutes at 14 mL/min before and every 15 minutes during 60 minutes of intermittent infusion and global ischemia; deoxy-KHB (ii), multidose deoxygenated (95% nitrogen/5% carbon dioxide) KHB infused for 3 minutes at 14 mL/min before and every 15 minutes during 60 minutes of intermittent infusion and global ischemia; oxyesmolol (iii), multidose oxygenated (95% oxygen/5% carbon dioxide) esmolol infused for 3 minutes at 14 mL/min before and every 15 minutes during 60 minutes of intermittent infusion and global ischemia; and deoxyesmolol (iv), multidose deoxygenated (95% nitrogen/5% carbon dioxide) esmolol infused for 3 minutes at 14 mL/min before and every 15 minutes during 60 minutes of intermittent infusion and global ischemia. All protocols were followed by 60 further minutes of reperfusion, when recovery of myocardial function was measured. Study 1B, Hearts were randomly assigned to one of three groups (n = 6 per group): STH2 (v), multidose normoxic (equilibrated with room air) STH2 infused for 3 minutes at 45 mm Hg before and every 15 minutes during 60 minutes of intermittent infusion and global ischemia; oxy-STH2 (vi), multidose oxygenated (95% oxygen/5% carbon dioxide) STH2 infused for 3 minutes at 45 mm Hg before and every 15 minutes during 60 minutes of intermittent infusion and global ischemia; and oxyesmolol (vii), multidose oxygenated (95% oxygen/5% carbon dioxide) esmolol infused for 3 minutes at 45 mm Hg before and every 15 minutes during 60 minutes of intermittent infusion and global ischemia. All protocols were followed by 60 further minutes of reperfusion, when recovery of myocardial function was measured. Study 2, Hearts were randomly assigned to one of four ischemic duration groups: 60, 75, 90, and 120 minutes of ischemia. In addition, for each ischemic duration group, hearts were randomly assigned to four treatment groups (n = 6 per group): multidose KHB infused at constant flow (CF) for 3 minutes at 14 mL/min before and every 15 minutes during intermittent infusion and global ischemia, multidose KHB infused at constant pressure (CP) for 3 minutes at 45 mm Hg before and every 15 minutes during intermittent infusion and global ischemia, multidose esmolol cardioplegia infused at constant flow for 3 minutes at 14 mL/min before and every 15 minutes during intermittent infusion and global ischemia, and multidose esmolol cardioplegia infused at constant pressure for 3 minutes at 45 mm Hg before and every 15 minutes during intermittent infusion and global ischemia. All protocols were followed by 60 further minutes of reperfusion, when recovery of myocardial function was measured. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /mtc ) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

3 Fig. 2 Recovery of LVDP (expressed as percentage of preischemic control value) throughout 60 minutes of reperfusion. A, Study 1A. Filled diamonds represent oxy-KHB; open diamonds represent deoxy-KHB; filled circles represent oxygenated esmolol (infused at 14 mL/min); open circles represent deoxygenated esmolol. B, Study 1B. Open triangles represent STH2; filled triangles represent oxy-STH2; filled squares represent oxygenated esmolol (infused at 45 mm Hg). Data points represent mean; error bars represent SEM; n = 6 hearts/group. Pound sign indicates P <.01 versus all other groups. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /mtc ) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

4 Fig. 3 Recovery of coronary flow (expressed as percentage of preischemic control value) throughout 60 minutes of reperfusion. A, Study 1A. Filled diamonds represent oxy-KHB; open diamonds represent deoxy-KHB; filled circles represent oxygenated esmolol (infused at 14 mL/min); open circles represent deoxygenated esmolol. B, Study 1B. Open triangles represent STH2; filled triangles represent oxy-STH2; filled squares represent oxygenated esmolol (infused at 45 mm Hg). Data points represent mean; error bars represent SEM; n = 6 hearts/group. Asterisk indicates P <.05 versus all other groups; pound sign indicates P <.01 versus all other groups. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /mtc ) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

5 Fig. 4 Changes during global ischemia in infusion pressure at each constant-flow infusion in study 1A (A) and infusion volume at each constant-pressure infusion in study 1B (B). A, Study 1A. Filled diamonds represent oxy-KHB; open diamonds represent deoxy-KHB; filled circles represent oxygenated esmolol (infused at 14 mL/min); open circles represent deoxygenated esmolol. B, Study 1B. Open triangles represent STH2; filled triangles represent oxy-STH2; filled squares represent oxygenated esmolol (infused at 45 mm Hg). Data points represent mean; error bars represent SEM; n = 6 hearts/group. Dagger indicates P <.05 versus oxy-KHB and oxyesmolol groups; double dagger indicates P <.01 versus first infusion; pound sign indicates P <.05 versus first infusion; asterisk indicates P <.05 versus all other groups. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /mtc ) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

6 Fig. 5 Recovery of LVDP (A, expressed as percentage of preischemic control value) and LVEDP (B) with increasing durations of global ischemia (study 2). Filled diamonds represent KHB at constant flow; open inverted triangles represent KHB at constant pressure; filled circles represent esmolol at constant flow; and filled squares represent esmolol at constant pressure. Data points represent mean; error bars represent SEM; n = 6 hearts/group. Double dagger indicates P <.01 versus KHB at constant flow and KHB at constant pressure; asterisk indicates P <.01 versus all other groups; dagger indicates P <.05 versus all other groups. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /mtc ) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

7 Fig. 6 Changes during global ischemia in study 2 in infusion volume at each constant-pressure infusion (A) and infusion pressure at each constant-flow infusion (B). Open circles represent KHB; filled circles represent esmolol. Data points represent mean; error bars represent SEM; n = at least 6 hearts/group. Asterisk indicates P <.05 versus esmolol in A, and P <.001 versus KHB in B. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /mtc ) Copyright © 2002 American Association for Thoracic Surgery Terms and Conditions

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