PRECONDITIONING THE HUMAN HEART DURING AORTOCORONARY BYPASS-SURGERY

被引：78

作者：

ALKHULAIFI, AM

YELLON, DM

PUGSLEY, WB

机构：

[1] Department of Cardiothoracic Surgery, The Middlesex Hospital, London, WlN 8AA, Mortimer Street

[2] Hatter Institute for Cardiovascular Studies, Division of Cardiology, University College Hospital, London

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1994年 / 8卷 / 05期

关键词：

PRECONDITIONING; INTERMITTENT AORTIC CROSS-CLAMPING; ATP;

D O I：

10.1016/1010-7940(94)90159-7

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Ischaemic preconditioning, with brief periods of ischaemia separated by reperfusion, increases myocardial resistance to infarction. In addition, preconditioning leads to preservation of myocardial adenosine triphosphate (ATP) during ischaemia. We propose that ischaemic preconditioning may share fundamental similarities with intermittent aortic cross-clamping utilised during aorto-coronary bypass surgery. The aim of this study was to test the hypothesis that controlled aortic cross-clamping is a form of preconditioning using conservation of ATP as the end point. Patients randomised to the preconditioned group (preconditioned, n = 10 patients), received a preconditioning stimulus of two 3-min periods of cross-clamping separated by 2 min of reperfusion prior to an ischaemic insult of 10 min ischaemia and ventricular fibrillation. In the control group (control, n = 10 patients) hearts received 10 min cross-clamping with fibrillation without prior preconditioning. Myocardial ATP, creatine phosphate (CP), and lactate were determined from biopsy specimens taken at the onset of cardiopulmonary bypass (A), at the end of preconditioning (B), and at the end of 10 min of ischaemic insult (C). Results: expressed as mean +/- SE (mumol/g dry weight). Preconditioning resulted in a significant depletion of the myocardial ATP content (preconditioned, B: 11.7 +/- 0.9 vs A: 19.8 +/- 1.4; P < 0.01). Furthermore 10 min of ischaemia resulted in a significant depletion of ATP in the control patients (control, C: 7.2 +/- 0.3 vs B: 19.5 +/- 1.2; P < 0.005). Preconditioning slowed down the rate of myocardial ATP depletion in the preconditioned group to such an extent that, at the end of the prolonged ischaemic insult, preconditioned hearts had significantly higher ATP content than the controls (preconditioned, C: 11.5 +/- 0.8 vs control, C: 7.2 +/- 0.3; P < 0.005). Pronounced effects of ischaemia on myocardial CP content and lactate production were also observed. These data demonstrate that ischaemic preconditioning with two 3-min periods of aortic cross-clamping, separated by 2 min of reperfusion, limit myocardial ATP wastage during a 10-min period of sustained ischaemia. This may suggest that controlled intermittent aortic cross-clamping may be a form of ischaemic preconditioning and may offer protection to the myocardium during extensive aorto-coronary bypass surgery.

引用

页码：270 / 276

页数：7

共 36 条

[1] Asimakis G.K., Inners-Mc Bride K., Medelin G., Conti V.R., Ischaemic preconditioning attenuates acidosis and post- ischaemic dysfunction in isolated rat heart, Am J Physiol, 32, pp. H887-H892, (1992)
[2] Bolli R., Mechanism of myocardial stunning, Circulation, 82, pp. 723-738, (1990)
[3] Braunwald E., Kloner R.A., The stunned myocardium: Prolonged, postischaemic ventricular dysfunction, Circulation, 66, pp. 1146-1149, (1982)
[4] Bunchek L.I., Burlingame M.W., Coronary artery bypass without cardioplegia, J Thorac Cardiovasc Surg, 93, pp. 261-267, (1987)
[5] Gay W.A., Ebert P.A., Functional, metabolic, and morphologic effects of potassium-induced cardioplegia, Surgery, 74, pp. 284-290, (1973)
[6] Geft I.L., Fishbein M.C., Ninomiya K., Hashida J., Caux E., Yano J., Y-Rit J., Genov T., Shell W., Ganz W., Intermittent brief periods of ischaemia have a cumulative effect and may cause myocardial necrosis, Circulation, 66, pp. 1150-1153, (1982)
[7] Gross G.J., Auchampach J.A., Blockade of ATP-sensitive potassium channels prevents myocardial preconditioning in dogs, Circ Res, 70, pp. 223-233, (1992)
[8] Heads R.J., Patel V.C., Latchman D.S., Yellon D.M., Ischaemic preconditioning causes rapid elevation of 65 kDa stress protein in rabbit heart, J Mol Cell Cardiol, 24, (1992)
[9] Hearse D.J., Stewart D.A., Braimbridge M.V., The additive effects of hypothermia and chemical cardioplegia during ischaemic cardiac arrest in the rat, J Thorac Cardiovasc Surg, 79, pp. 39-43, (1980)
[10] Heyndrickx G.R., Millard R.W., Mc Richie R.J., Maroko P.R., Vanter S.F., Regional myocardial function and electro- physiological alterations after brief coronary artery occlusion in conscious dogs, J Clin Invest, 56, pp. 978-985, (1975)

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