Right and left ventricular metabolites

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 96; no. 5; pp. 725 - 729
• Main Authors: Teoh, KH, Mullen, JC, Weisel, RD, Christakis, GT, Madonik, MM, Ivanov, J, Mickle, DA
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA AATS/WTSA 01.11.1988; Elsevier
• Subjects: Adenosine Triphosphate - metabolism; Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood; Body Temperature; Coronary Artery Bypass; Heart Arrest, Induced; Humans; Medical sciences; Middle Aged; Myocardial Reperfusion; Myocardium - metabolism; Phosphocreatine - metabolism; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; Cardiopulmonary bypass; Prevention; Cardioplegic solution; Energy metabolism; Ischemia; Biopsy; Surgery; Right ventricle; Coronary artery; Myocardium; General anesthesia; Left ventricle
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/s0022-5223(19)35179-7

Current methods of cardioplegic delivery may delay the recovery of right ventricular metabolism and function. To evaluate right and left ventricular metabolism, we performed biopsies in 37 patients undergoing elective coronary bypass operation with aortic root blood cardioplegia. Right ventricular temperatures were warmer than left ventricular temperatures during cardioplegic arrest (right ventricle: 16.8 degrees +/- 3.8 degrees C, left ventricle: 14.3 degrees +/- 3.7 degrees C, p = 0.02). Adenosine triphosphate concentrations were lower in the right ventricle than in the left ventricle before cardioplegic arrest (right ventricle: 13.8 +/- 7.8 mmol/kg, left ventricle: 21.5 +/- 8.7 mmol/kg, p = 0.02). After reperfusion, right ventricular adenosine triphosphate concentrations fell to low levels (10 +/- 6 mmol/kg). Postoperative left and right ventricular high energy phosphate concentrations (the sum of adenosine triphosphate and creatine phosphate levels) correlated inversely with myocardial temperatures during cardioplegia (r = -0.29, p = 0.048). Aortic root cardioplegia did not cool the right ventricle as well as it did the left ventricle. The lower preoperative high energy phosphate concentrations may have increased the susceptibility of the right ventricle to ischemic injury. Alternative methods of myocardial preservation may improve right ventricular cooling and protection.