Initial Reperfusion with Magnesium after Cardioplegic Arrest Attenuates Myocardial Reperfusion Injury

F. Fuchs; K. Messmer; H. Kuppe; H. Habazettl

doi:10.1055/s-2002-33091

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2002; 50(4): 208-215
DOI: 10.1055/s-2002-33091

Original Cardiovascular

Original Paper
© Georg Thieme Verlag Stuttgart · New York

Initial Reperfusion with Magnesium after Cardioplegic Arrest Attenuates Myocardial Reperfusion Injury[*]

F. Fuchs¹ , K. Messmer¹ , H. Kuppe² , H. Habazettl³

¹Institute for Surgical Research, Ludwig-Maximilians-Universität München, Germany
²Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Germany
³Department of Physiology, Freie Universität Berlin, Germany

The results from this study were presented in part at the Chirurgische Forschungstage 2000, Marburg, Germany, and at the Annual Meeting of the American Society of Anesthesiologists 2001, New Orleans, USA

Abstract

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Abstract

Background: Magnesium's effect on calcium ion concentrations may attenuate myocardial reperfusion injury. The aim of this study was therefore to investigate the effects on the recovery of myocardial function of initial reperfusion with varying Mg²⁺ concentrations following cardioplegic arrest. Methods: Isolated guinea pig hearts underwent 3.5 hours of cardioplegic arrest in St. Thomas Hospital II solution (STH) or Bretschneider HTK solution (HTK) at 24° C. Control hearts were reperfused with normal Krebs-Henseleit solution (KHS). In the therapy groups, hearts were initially reperfused with 5, 10, or 20 mM Mg²⁺ for 15 minutes, followed by 30 minutes of perfusion with KHS. Results: During initial reperfusion, elevated Mg²⁺ concentrations markedly reduced rate-pressure product, dP/dt and O₂ demand. Release of LDH and CK was reduced in the therapy groups pretreated with Bretschneider HTK. After Mg²⁺ washout, left ventricular function recovery and compliance was improved after HTK but not after STH cardioplegia. Following both STH and HTK cardioplegia, Mg²⁺ reperfusion reduced reperfusion arrhythmias. Conclusions: The combination of HTK cardioplegia with 15 min initial Mg²⁺ (5 and 10 mM, but not 20 mM) reperfusion was clearly superior to HTK followed by immediate Krebs-Henseleit reperfusion as well as STH cardioplegia with or without initial Mg²⁺ reperfusion. The high Mg²⁺ concentrations in the STH solution might mask beneficial effects of Mg²⁺ reperfusion.

Key words

Magnesium - Calcium - Reperfusion injury - Cardioplegic solutions

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References

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1 The results from this study were presented in part at the Chirurgische Forschungstage 2000, Marburg, Germany, and at the Annual Meeting of the American Society of Anesthesiologists 2001, New Orleans, USA

Helmut Habazettl

Department of Physiology, Freie Universität Berlin

Arnimallee 22

14195 Berlin

Germany

Phone: +49 (30) 8445-1638

Fax: +49 (30) 8445-1634

Email: habazett@zedat.fu-berlin.de