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ЗАДАТЬ ВОПРОС РЕДАКТОРУ РАЗДЕЛА (ответ в течение нескольких дней)

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17 января 2002 00:00

Fractal or biologically variable delivery of cardioplegic solution prevents diastolic dysfunction after cardiopulmonary bypass

Objective: To determine whether myocardial protection is improved by restoring physiologic variability to the cardioplegia pressure signal during cardiopulmonary bypass, we compared cardiac function in pigs in the first hour after either conventional cold-blood cardioplegia (group CC) or computer-controlled biologically variable pulsatile cardioplegia (group BVC).
Methods: Invasive monitors and sonomicrometry crystals were placed, and cardiopulmonary bypass was initiated. The aorta was crossclamped, and cold blood cardioplegic solution was infused intermittently through the aortic root with either conventional cardioplegia (n = 8) or biologically variable pulsatile cardioplegia (n = 8; mean pressure, 75 mm Hg for 85 minutes). The crossclamp was released, cardiac function was restored, and separation from cardiopulmonary bypass was completed. With stable temperature and arterial blood gases, hemodynamics and systolic and diastolic indices were compared at 15, 30, and 60 minutes after cardiopulmonary bypass.
Results: Diastolic stiffness doubled from 0.027 ± 0.016 mm Hg/mm (mean ± SD) at baseline to 0.055 ± 0.036 mm Hg/mm (P = .003) at 1 hour after bypass in group CC, associated with increased left ventricular end-diastolic pressure from 9 ± 2 to 11 ± 2 mm Hg (P = .001), mean pulmonary artery pressure from 14 ± 2 to 20 ± 3 mm Hg (P = .003), and serum lactate levels from 2.0 ± 0.5 to 5.6 ± 2.3 mmol/L (P = .008). Systolic function was not affected. In group BVC diastolic stiffness, left ventricular end-diastolic pressure, and pulmonary artery pressure values were not different from control values at any time after bypass, and serum lactate levels were significantly less than with conventional cold blood cardioplegia. Peak pressure variability with biologically variable pulsatile cardioplegia fit a power-law equation (exponent = –3.0; R2 = 0.97), indicating fractal behavior.
Conclusion: Diastolic cardiac function is better preserved after cardiopulmonary bypass with biologically variable pulsatile cardioplegia and fractal perfusion. This may be attributed to enhanced microcirculatory perfusion with improved myocardial protection. A model supporting these results is presented.



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