The effects of warm versus cold blood cardioplegia on endothelial function, myocardial function, and energetics

Recent interest in the use of normothermic blood cardioplegia is based on theoretical advantages over the traditional method of hypothermic myocardial protection. This study was designed to compare the effects of warm and cold blood cardioplegia on left ventricular functions and energetics and coronary responsiveness.

Two groups of mongrel dogs (n = 7 each) underwent either normothermic cardiopulmonary bypass (CPB) with continuous warm (37 degrees C) blood cardioplegia or hypothermic (26 degrees C) CPB with a single dose of cold (4 degrees C) blood cardioplegia supplemented with topical cooling during 30 minutes of aortic clamping. There was no deterioration in the endothelium-dependent and -independent coronary relaxation as tested by the infusion of acetylcholine and nitroglycerin after cardioplegic arrest for either group. At 60 minutes of reperfusion, both groups had complete recovery of left ventricular contractility as measured by the preload recruitable stroke work area derived from the measurement of the ventricular pressure (micromanometer catheter) and volume (conductance catheter) relation. The analysis of myocardial energetics in terms of the myocardial oxygen consumption-pressure volume area relation did not reveal any significant changes between the y-intercepts and the slopes of the two groups.

For 30 minutes of aortic cross-clamp time, continuous warm cardioplegia did not provide any benefit over a single injection of cold cardioplegia in coronary endothelial and smooth muscle function, myocardial function, and energetics.