Warm blood hyperkalaemic reperfusion ('hot shot') prevents myocardial substrate derangement in patients undergoing coronary artery bypass surgery

Abstract

Objective: A significant metabolic derangement occurs in the ischaemic-reperfused heart of patients undergoing coronary artery bypass surgery using cold blood cardioplegia. The aim of the present study was to investigate whether this effect could be reversed by complementing cold blood cardioplegia with a short terminal exposure of warm blood hyperkalaemic cardioplegia ('hot shot').

Methods: Thirty-five patients undergoing primary elective coronary revascularisation were randomized to one of two different techniques of myocardial protection. In the cold blood group (n = 17) myocardial protection was induced using antegrade hyperkalaemic cold blood cardioplegic solution. In the hot shot group (n = 18) this was supplemented with a short exposure to hyperkalaemic warm blood cardioplegia prior to removal of the cross clamp. Intracellular substrates (ATP and amino acids) were measured in left ventricular biopsies collected 5 min after institution of cardiopulmonary bypass, after 30 min of ischaemic arrest and 20 min after reperfusion.

Results: Biopsies taken at the end of the period of myocardial ischaemia, when compared to control, did not show any significant change in the intracellular concentration of ATP (from 2.71 +/- 0.32 to 2.43 +/- 0.37 micromol g wet for cold blood group and from 2.6 +/- 0.3 to 2.5 +/- 0.34 micromol/g wet weight for hot shot group) or total free intracellular amino acids pool (from 33.0 +/- 1.4 to 30.0 +/- 1.4 micromol/g wet weight for cold blood group and from 34.0 +/- 1.4 to 34.5 +/- 2.3 micromol/g wet weight for hot shot group). Upon reperfusion, however, there was a significant fall in ATP (23.7 +/- 1.6 micromol/g wet weight amino acids, P < 0.05) and in amino acids (1.53 +/- 0.24 micromol/g wet weight, P < 0.05) in the group receiving only cold blood cardioplegia but not in the hot shot group (2.27 +/- 0.27 micromol/g wet weight ATP and 30.5 +/- 1.6 micromol/g wet weight amino acids).

Conclusions: The data suggest that warm blood hyperkalaemic reperfusion hot shot prevents myocardial metabolic derangement seen during coronary artery surgery.