The role of magnesium in myocardial preservation

The purpose of this review is to look at the role of magnesium in the formation of preservation and reperfusion solutions for the ischaemic heart. Preservation of the heart during cardiac surgery procedures, including cardiac transplantation, can be divided into distinct phases: arrest, cold storage in the case of transplantation, global ischaemia during implantation or cardiac surgery procedures, followed by reperfusion when the heart is rewarmed and restarted. Although the magnesium ion can play a significant role in myocardial protection, it is important to recognize the different types of protection required during these different phases of surgical procedures. The rationale for the inclusion of magnesium in cardioplegic solutions is threefold: (i) for its negative inotropic effect; (ii) to prevent ischaemia-induced magnesium loss; (iii) to influence cellular ionic movements. Preservation temperature as well as the concentration of other ionic constituents present in the preservation solution alter the effects of magnesium. Results obtained from animal models suggest that elevated magnesium (16 mM) is beneficial to the hypothermic preservation of hearts with extracellular type solutions, especially when calcium is elevated in the solution formulation. Research has shown that the amplitude of the inotropic effect of magnesium varies from one species to another so that the beneficial effect of magnesium is inferior in the less sensitive species. Using the human atrial trabecular preparation as a model for myocardial preservation, we have assessed the effects of elevated magnesium on the recovery of developed force, both for long-term preservation (24 h) during hypothermic arrest (4 degrees C) and for reperfusion during rewarming of the trabeculae. No clear pattern emerged when the ratio of calcium to magnesium was altered in St Thomas' I and II solutions used for the storage. However, when the atrial trabecular preparation was rewarmed in a Krebs Henseleit buffer containing an elevated level of magnesium (16 mM), a greater number of trabeculae reached a greater developed force and had higher levels of energetic metabolites than when the magnesium in the Krebs Henseleit buffer was 1.2 mM. Several studies have suggested that an elevated magnesium prevents calcium overload by competing with this ion at the membrane, and reduces the workload, while ATP reserves and ion homoeostasis are re-established. The role of the magnesium ion in hypothermic preservation of the human myocardium is still not clear after many clinical and experimental studies and requires further investigation.(ABSTRACT TRUNCATED AT 400 WORDS)