Effects of cold and warm blood cardioplegia assessed by myocardial pH and release of metabolic markers

Abstract

The optimal temperature of blood cardioplegia remains controversial. Interstitial myocardial pH was monitored online with a probe that was inserted in the anterior wall of the left ventricle. Venous pH, lactate production, and creatine kinase and troponin T release were measured in coronary sinus blood obtained in 14 dogs after ischemic arrest periods of 5, 10, 20, and 40 minutes with warm (n = 7; mean myocardial temperature, 35 ° ± 2 °C) and cold (n = 7; mean myocardial temperature, 12 ° ± 1 °C) blood cardioplegic protection. Blood cardioplegic solution was delivered at a rate of 100 mL/min during the 10 minutes between each ischemic arrest. The interstitial myocardial pH decreased significantly ( p < 0.05) from 7.1 ± 0.3 to 6.53 ± 0.3 after ischemia in animals perfused with warm blood cardioplegia and from 7.04 ± 0.3 to 6.64 ± 0.1 in those receiving cold blood cardioplegic protection; however, the difference between the groups was not significant ( p > 0.05). Lactate production and creatine kinase and troponin T release increased significantly after ischemia, but there was no difference in the changes between the warm and cold blood cardioplegia groups. In conclusion, ischemia caused significant changes in all variables measured, and these changes were directly proportional to the duration of ischemia. However, there was no significant difference ( p > 0.05) in the myocardial metabolic changes between the warm and cold blood cardioplegia groups in terms of the duration of ischemic arrest studied. Thus, both warm and cold blood cardioplegia appear to confer a similar degree of myocardial protection, with similar metabolic changes occurring after short periods of ischemic arrest.