Background.The aim of this study was to compare the protective effects of continuous warm blood cardioplegia (CWBC) and intermittent warm blood cardioplegia (IWBC) in an experimental model of blood-perfused, isolated rabbit heart.Methods.In the CWBC group, cardiac arrest was induced by continuous infusion of blood cardioplegia (10 mEq/L KCI) followed by 30 minutes of reperfusion with blood. In the IWBC group, after 5 minutes of perfusion with blood cardioplegia (10 mEq/L KCl), coronary flow was abolished for 10 minutes, followed by reperfusion with blood cardioplegia for 5 minutes. This sequence was repeated three times for a total period of 45 minutes. Finally the hearts were reperfused for 30 minutes with blood.Results.Infusion of potassium induced a marked increase in coronary perfusion pressure (from 50 ± 3 to 98 ± 1 mm Hg; p < 0.01), which remained elevated throughout in the CWBC group, whereas in the IWBC group, it dropped to 0 during each no-flow period. In both groups, cardioplegia resulted in a significant reduction in oxygen consumption (from 5.5 ± 0.2 to 0.6 ± 0.03 mL O2 · min−1 · 100 g−1 wet wt; p < 0.01). During CWBC, glucose extraction was significantly reduced (from 152 ± 10 to 64 ± 18 μg · min−1 · g−1 wet wt; p < 0.01). Free fatty acid uptake and creatine kinase and lactate release were not affected. During IWBC, in contrast, a transient but significant release of creatine kinase (from 643 ± 254 to 2,234 ± 296 mU · min−1 · g−1 wet wt; p < 0.01) and lactate (from 63 ± 22 to 374 ± 32 μg · min−1 wet wt; p < 0.01) occurred after each period of ischemia. Despite these metabolic differences, both cardioplegic procedures allowed a prompt and complete recovery of mechanical function and tissue content of high-energy phosphates.Conclusions.Both CWBC and IWBC exert optimal protection in the isolated blood perfused rabbit heart. Thus, IWBC can be safely used to improve visualization of the surgical field.

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   |texte=   Continuous versus intermittent warm blood cardioplegia: Functional and energetics changes
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