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

[11] Horst H.L., Lactate determination with lactic dehydrogenase and DPN, Methods of Enzymatic Analysis, pp. 266-277, (1963)
[12] Jennings R.B., Hawkins H.K., Lowe J.E., Hill M.L., Sherry Klot-Man B.S., Reimer K.A., Relation between high energy phosphate and lethal injury in myocardial ischaemia in the dog, Am J Path, 92, pp. 187-214, (1978)
[13] Jennings R.B., Reimer K.A., Hill M.A., Mayer S.E., Total ischaemia in dog hearts, in vitro: 1. Comparison of high energy phosphate production, utilisation, and depletion, and of adenine nucleotide catabolism in total ischaemia in vitro vs severe ischaemia in vivo, Circ Res, 49, pp. 892-900, (1981)
[14] Kida M., Yokota R., Tanaka M., Effect of ischaemic preconditioning on energy metabolism during short sustained ischaemia and reperfusion in pig hearts, J Moll Cell Cardiol, 24, (1992)
[15] Kiibler W., Spieckermann P.G., Regulation of glycolysis in the ischaemic and the anoxic myocardium, J Moll Cell Cardiol, 1, pp. 351-377, (1970)
[16] Lamprecht W., Trautschold I., Determination of ATP with hexokinase and glucose-6-phosphate dehydrogenase, Methods of Enzymatic Analysis, pp. 2102-2110, (1974)
[17] Lazar H.L., Roberts A.J., Recent advances in cardiopulmonary bypass and the clinical application of myocardial protection, Surg Clin North Am, 65, pp. 455-476, (1985)
[18] Lazar H.L., Buckberg G.D., Managanaro A.M., Foglia R., Beckberg H., Mulder D., Maloney J., Reversal of ischaemic damage with secondary blood cardioplegia, J Thorac Cardiovasc Surg, 78, pp. 688-697, (1979)
[19] Lazar H.L., Buckberg G.D., Manganaro A.M., Becker H., Myocardial energy replenishment and reversal of ischemic damage by substrate enhancement of secondary cardioplegia with amino acids during reperfusion, J Thorac Cardiovasc Surg, 80, pp. 350-359, (1980)
[20] Li Y., Whittaker P., Kloner R.A., The transient nature of the effect of ischaemic preconditioning on myocardial infarct size and ventricular arrhythmia, Am Heart J, 123, pp. 346-353, (1992)

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