Continuous Intraoperative Assessment of Interstitial pH: Development of Miniature Myocardial Unit, Prediction of Recovery of Left Ventricular Function, Assessment of Adequacy of Myocardial Preservation
Nowlen, Todd T.
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No universally accepted method exists for assessing intraoperatively the adequacy of myocardial protection. In this study, the continuous measurement of intramyocardial pH and temperature was used to follow the progression of ischemia and predict functional level of recovery and adequacy of myocardial preservation following normothermia (38 degrees celcius), hypothermia (25 degrees celcius), and the administration of cardioplegia (38 degrees celcius). A new myocardial unit incorporating fiberoptic technology and dual pH and temperature sensing capability was designed and placed on the left ventricular free wall of sheep undergoing cardiopulmonary bypass. Left ventricular stroke work (LVSW) vs mean left atrial pressure curves were generated pre and post cardiopulmonary bypass by loading with whole blood for LA 5-15 mm Hg. Control sheep were not made ischemic. Ischemia was continued in all sheep until pH fell to 7.3, 7.0, 6.8, or 6.6. The results indicated that pH levels predict the left ventricular functional level of recovery in all groups and that the rate of change of pH (pH unit change per min.) assesses adequacy of myocardial protection by predicting the ischemic time interval required to achieve a given functional level of recovery.
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