Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Korn, P; Kröner, A; Schirnhofer, J; Hallström, S; Bernecker, O; Mallinger, R; Franz, M; Gasser, H; Wolner, E; Podesser, BK.
Quinaprilat during cardioplegic arrest in the rabbit to prevent ischemia-reperfusion injury.
J THORAC CARDIOVASC SURG 2002 124: 352-360.
Doi: 10.1067/mtc.2002.121676
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- Co-Autor*innen der Med Uni Graz
- Hallström Seth
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- Abstract:
- OBJECTIVES: This study evaluated intracardiac angiotensin-converting enzyme inhibition as an adjuvant to cardioplegia and examined its effects on hemodynamic, metabolic, and ultrastructural postischemic outcomes. METHODS: The experiments were performed with an isolated, erythrocyte-perfused, rabbit working-heart model. The hearts excised from 29 adult New Zealand White rabbits (2950 +/- 200 g) were randomly assigned to four groups. Two groups received quinaprilat (1 microg/mL), initiated either with cardioplegia (n = 7) or during reperfusion (n = 7). The third group received l-arginine (2 mmol/L) initiated with cardioplegia (n = 7). Eight hearts served as a control group. Forty minutes of preischemic perfusion were followed by 60 minutes of hypothermic arrest and 40 minutes of reperfusion. RESULTS: All treatments substantially improved postischemic recovery of external heart work (62% +/- 6%, 69% +/- 3%, and 64% +/- 5% in quinaprilat during cardioplegia, quinaprilat during reperfusion, and l-arginine groups, respectively, vs 35% +/- 5% in control group, P <.001) with similarly increased external stroke work and cardiac output. When administered during ischemia, quinaprilat significantly improved recovery of coronary flow (70% +/- 8%, P =.028 vs quinaprilat during reperfusion [49% +/- 5%] and P =.023 vs control [48% +/- 6%]). l-Arginine (55% +/- 7%) showed no significant effect. Postischemic myocardial oxygen consumption remained low in treatment groups (4.6 +/- 1.2 mL. min(-1). 100 g(-1), 6.0 +/- 2.2 mL. min(-1). 100 g(-1), and 4.7 +/- 1.6 mL. min(-1). 100 g(-1) in quinaprilat during cardioplegia, quinaprilat during reperfusion, and l-arginine groups, respectively, vs 4.2 +/- 0.8 mL. min(-1). 100 g(-1) in control group), even though cardiac work was markedly increased. High-energy phosphates, which were consistently elevated in all treatment groups, showed a significant increase in adenosine triphosphate with quinaprilat during ischemia (2.24 +/- 0.14 micromol/g vs 1.81 +/- 0.12 micromol/g in control group, P =.040). Ultrastructural grading of mitochondrial damage revealed best preservation with quinaprilat during ischemia (100% [no damage], P =.001 vs control). CONCLUSION: These experimental findings have clinical relevance regarding prevention of postoperative myocardial stunning and low coronary reflow in patients undergoing heart surgery.
- Find related publications in this database (using NLM MeSH Indexing)
- Analysis of Variance -
- Angiotensin-Converting Enzyme Inhibitors - pharmacology
- Animals - pharmacology
- Blood Gas Analysis - pharmacology
- Cardioplegic Solutions - pharmacology
- Heart Arrest, Induced - methods
- Hemodynamic Processes - methods
- Isoquinolines - pharmacology
- Mitochondria, Heart - ultrastructure
- Myocardial Reperfusion Injury - prevention and control
- Rabbits - prevention and control
- Research Support, Non-U.S. Gov't - prevention and control
- Tetrahydroisoquinolines - prevention and control