Preservation of myocardial high energy phosphates during cardioplegic arrest with nifedipine.

Nifedipine used both as an additive to cardioplegia solution (CPS) and as pretreatment prior to arrest was studied in a rat model to determine its effect upon ischemic ventricular electromechanical work during arrest and upon high energy phosphate levels. Fifty-one normothermic rats were studied in vivo with infusion of hypothermic (4 degrees C) CPS into the cross-clamped aortic root according to one of the following eight protocols: Group 1, baseline beating hearts; Group 2, CPS containing 15 mEq potassium chloride/liter (KCl/liter); Group 3, CPS containing 30 mEq KCl/liter; Group 4, CPS containing 15 mEq KCl/liter combined with stimulation of the vagus nerve; Groups 5 and 6, CPS with 15 mEq KCl/liter and containing 250 or 500 micrograms of nifedipine per liter; Groups 7 and 8, pretreatment with 100 or 200 micrograms nifedipine/kg given as an intravenous bolus 15 min prior to infusion of CPS with 15 mEq KCl/liter. Time to arrest, number of ischemic ventricular contractions after aortic cross clamping, and ATP and creatine phosphate (CP) levels were recorded. All nifedipine groups arrested more quickly and with fewer ventricular contractions and had ATP and CP levels higher than those of Group 2 (P less than 0.05). There were no differences between the nifedipine groups and Group 3 except that Group 8 (200 micrograms/kg pretreatment) resulted in higher levels of CP than Groups 3, 5, and 6 (P less than 0.05 for all groups). When all groups were combined, time to arrest correlated negatively with ATP (r = -0.863, P less than 0.01) and CP (r = -0.824, P less than 0.01) levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Duke Scholars

Author Mark Hisao Kadowaki Surgical Oncology