Normothermic Continuous Antegrade Blood Cardioplegia Does Not Prevent Myocardial Edema and Cardiac Dysfunction

Abstract

Background Normothermic continuous blood cardioplegia (BC) has been proposed to completely protect the myocardium during cardiac surgery. However, previous work from our laboratory suggests that BC could cause myocardial edema that produces cardiac dysfunction. The purpose of this present study was to evaluate the impact of BC on myocardial fluid balance and left ventricular function. Methods and Results In 11 dogs, myocardial water content (MWC) was determined by microgravimetry. Myocardial lymph flow rate was measured after cannulation of the major prenodal cardiac lymphatic. Preload recruitable stroke work (PRSW) was calculated by sonomicrometry and micromanometry. The dogs were placed on normothermic cardiopulmonary bypass (CPB), and BC was delivered at either 80 to 90 mm Hg (BC high ; n=6) or 40 to 50 mm Hg (BC low ; n=5) for 1 hour. Coronary sinus lactate and oxygen saturation monitoring demonstrated ischemia avoidance. BC was associated with substantial myocardial lymph flow rate decrease ( P <.05) and myocardial edema development in both groups. MWC increased from 76.0±1.9% to 79.2±1.7% ( P <.05) after 10 minutes of BC high and from 75.9±0.6% to 78.9±1.4% ( P <.05) after 30 minutes of BC low . PRSW decreased to 63±19% (BC high ) and 69±15% of control (BC low ) at 30 minutes after CPB ( P <.05). Myocardial lymph flow rate increases of threefold to fourfold that of control ( P <.05) resulted in significant myocardial edema reduction associated with PRSW improvement to 71±17% (BC high ) and to 78±11% (BC low ) at 2 hours after CPB. Conclusions We conclude that BC is associated with compromised cardiac function despite ischemia avoidance. This cardiac dysfunction is due to myocardial edema caused by the combination of increased myocardial microvascular fluid filtration and decreased myocardial lymph flow rate during BC.