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Recovery of left ventricular function after hypothermic global ischemia. Age-related differences in the isolated
Abstract:
The immature myocardium has a greater tolerance for ischemia than does the mature heart. The effect of ischemia when combined with hypothermia on the newborn heart is poorly understood but has important clinical applications. This study examined the metabolic and functional recovery after 90 minutes of global ischemia at 20 degrees C in neonatal (1 week), immature (1 month), and mature (4 month) isolated working rabbit hearts. Following ischemia, aortic flow, cardiac output, heart rate, and stroke work remained at baseline values for neonatal hearts. Only coronary flow was significantly reduced from a control level of 4.5 +/- 1.4 (standard error of the mean) to 3.3 +/- 1.1 ml/min, p less than 0.05. In the immature group, hemodynamic parameters were below baseline, although no statistical differences were noted. Among mature hearts, however, all hemodynamic values were significantly below preischemic control. Water content was significantly higher in immature (73.2% +/- 1.4%) and mature (75.3% +/- 2.5%) hearts when compared with the neonatal group (46.8% +/- 4.6%), p less than 0.001. Coronary sinus creatine kinase was unchanged from baseline at 10 and 30 minutes following ischemia in the neonatal group. Although demonstrating substantial increases from baseline, statistical significance was not seen in the immature group because of the wide variation about the mean. In the mature group, creatine kinase rose significantly from preischemic levels of 15.4 +/- 4.3 IU/L/gm to 184.2 +/- 51.6 IU/L/gm at 10 minutes (p less than 0.01) and 123.7 +/- 31.9 IU/L/gm at 30 minutes (p less than 0.05). This study demonstrated improved tolerance to prolonged hypothermic ischemia in neonatal rabbit hearts when compared with older hearts subjected to the same conditions. The role of cardioplegic solutions in protecting the neonatal heart during cardiac operations when deep hypothermia is used may be of lesser importance than in the older patient.