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Myocardial protection: efficacy of a novel magnesium-based cardioplegia (RS-C) compared to St Thomas' Hospital cardioplegic solution

Cardiac Surgical Research/Cardiothoracic Surgery, The Rayne Institute (King's College London), Guy's and St Thomas' Hospital, London SE1 7EH, UK

*Corresponding author. Tel.: +44 207 1880958; fax: +44 207 1880970.

E-mail address: david.chambers{at}kcl.ac.uk (D.J. Chambers).

Cardiac surgery patients now tend to be sicker with more severe disease; consequently, improved protection is important. We compared St Thomas' Hospital solution (STH2: hyperkalaemia and hypermagnesaemia) to a hypermagnesaemia-alone cardioplegia (RS-C) based on a novel non-phosphate buffered crystalloid solution (Aqix^®RS-I). Isolated Langendorff-perfused rat hearts were used (function measured). Initial studies established optimal magnesium concentration as 25 mmol/l (LVDP recovery after 50 min at 37 °C global ischaemia (GI) for 16, 25, 35, 50 mmol/l magnesium vs. STH2 was 48±3, 50±2, 50±3, 30±3 and 51±2%, respectively). Contracture-related measurements (onset time, peak) for 25 mmol/l RS-C (32±1 min, 35±1 mmHg) compared favourable (P<0.05) to STH2 (26±1 min, 43±2 mmHg). LVDP recovery after a single 2-min cardioplegic infusion (with RS-C-25 or STH2) and 20, 30, 40 or 50 min GI was higher for RS-C-25 than STH2 after 20 min GI (81±1% vs. 74±1%; [P<0.05]) but similar at other GI durations. Subsequent multi-infusion studies (60 min GI, 3x2 min infusions every 20 min) demonstrated significantly improved recovery with RS-C-25 vs. STH2 (LVDP: 73±2%, 44±1% [P<0.001]; LVEDP: 9±2 mmHg, 45±2 mmHg [P<0.001]). We conclude that single RS-C infusion with optimal 25 mmol/l magnesium improved protection after short (20 min) GI durations, or after multi-infusions during prolonged (60 min) GI durations. Magnesium-based cardioplegia may be a useful alternative to hyperkalaemic cardioplegia under certain specific conditions.

Key Words: Myocardial protection; Cardioplegia; Magnesium

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eComment: Myocardial protection: efficacy of a novel magnesium-basedcardioplegia (RS-C) compared to St Thomas' Hospital cardioplegic solution

Leo A. Bockeria, Ruben R. Movsesyan, Dmitriy V. Ryabtsev, and Tigran R. Grigoryants
Interactive CardioVascular and Thoracic Surgery 2008 7: 749. [Full Text] [PDF]

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				L. A. Bockeria, R. R. Movsesyan, D. V. Ryabtsev, and T. R. Grigoryants eComment: Myocardial protection: efficacy of a novel magnesium-basedcardioplegia (RS-C) compared to St Thomas' Hospital cardioplegic solution Interactive CardioVascular and Thoracic Surgery, October 1, 2008; 7(5): 749 - 749. [Full Text] [PDF]