Thorac Cardiovasc Surg 2013; 61 - OP222
DOI: 10.1055/s-0032-1332461

NO-donor S-NO-HSA preserves cardiac function during local and global ischemia

M Kreibich 1, E Dzilic 1, D Santer 1, J Krynicka 1, S Hallström 1, 2, BK Podesser 1, 3, K Trescher 1, 3
  • 1Ludwig Boltzmann Cluster für Kardiovaskuläre Forschung, Vienna Working Heart Research Group, Wien, Austria
  • 2Medizinische Universität Graz, Institut für Physiologische Chemie, Graz, Austria
  • 3Landeskrankenhaus St. Pölten, Abteilung für Herzchirurgie, St. Pölten, Austria

Objectives: We compared the new Custodiol-N cardioplegia to its clinical precursor Custodiol in acute damaged rat hearts. In a second step we wanted to investigate the effects of the NO-donor S-NO-HSA (NO) during in vivo ACS as well as ex vivo during global cardioplegia.

Methods: After 60' of LAD ligature followed by 120' of in vivo reperfusion, hearts of male SD-rats were excised and evaluated in an erythrocyte perfused isolated working heart during 45' baseline measurements, 60' of Custodiol [group 1: n = 8], Custodiol-N [group 2: n = 8], or S-NO-HSA enriched Custodiol-N [group 3: n = 8; group 4: n = 8] protected ischemia and 45' of postischemic reperfusion. Group 4 also received i.v. NO treatment during myocardial infarction for 75' (0.27µmol/kg/h). Infarct size (IS) and area at risk (AAR) were controlled by Evans Blue and TTC staining. Blood gas analyses were performed before and after cardioplegia.

Results: Staining revealed equal IS (control: 39 ± 3% vs. treatment: 38 ± 2% n.s.), while AAR (control: 79 ± 7% vs. treatment: 55 ± 3% p ≤0.05) was significantly reduced after NO treatment. Also, NO treatment significantly improved hemodynamic baseline values. Significantly better recovery was observed in the S-NO-HSA treatment groups: External Heart Work (Custodiol: 74 ± 3% vs. Custodiol-N: 84 ± 3% n.s.; Custodiol vs. Custodiol-N+NO: 97 ± 4% p ≤0.05; Custodiol vs. Custodiol-N+NO+i.v. NO: 105 ± 7% p ≤0.01), LVPsys (Custodiol: 96 ± 1% vs. Custodiol-N: 94 ± 1% n.s.; Custodiol vs. Custodiol-N+NO: 101 ± 1% n.s.; Custodiol vs. Custodiol-N+NO+i.v. NO: 114 ± 5% p ≤0.01), CF (Custodiol: 79 ± 5% vs. Custodiol-N: 95 ± 3% n.s.; Custodiol vs. Custodiol-N+NO: 118 ± 6% p ≤0.01; Custodiol vs. Custodiol-N+NO+i.v. NO: 112 ± 3% p ≤0.01). Blood gas analyses showed significantly increased recovery of MDO2 (Custodiol: 82 ± 1% vs. Custodiol-N: 96 ± 5% p ≤0.05; Custodiol vs. Custodiol-N+NO: 105 ± 5% p ≤0.01; Custodiol vs. Custodiol-N+NO+i.v. NO: 112 ± 9% p ≤0.01) whereas MVO2 (Custodiol: 76 ± 4% vs. Custodiol-N: 99 ± 2% n.s.; Custodiol vs. Custodiol-N+NO: 102 ± 4% p ≤0.05; Custodiol vs. Custodiol-N+NO+i.v. NO: 112 ± 8% p ≤0.05) was significantly enhanced only after NO addition.

Conclusion: Custodiol-N shows superior recovery. Further improvement was observed through NO addition to the cardioplegia or trough in vivo application. This might be due to enhanced endothelial protection. We believe that S-NO-HSA is an interesting therapeutic option for patients with ACS and PTCA as well as for patients undergoing bypass surgery.