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Myocardial redox state during coronary artery bypass grafting assessed with microdialysis

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Abstract

Purpose

Microdialysis allows the biochemical analysis of interstitial fluids of nearly every organ as a bedside procedure. This technique could be useful to reveal data about the myocardial metabolism during cardiopulmonary bypass in human coronary artery bypass graft (CABG) surgery.

Methods

In 17 patients undergoing CABG a myocardial microdialysis catheter (CMA 70, CMA/Microdialysis AB, Sweden) was inserted in the apical region of the beating heart. Microdialysis measurements were performed at timed intervals before, during, and after cardiopulmonary bypass (CPB). The concentrations of lactate and pyruvate were analyzed semi-continuously.

Results

During CPB the myocardial lactate- pyruvate- ratio (LPR) rose from an initial 11 (8–15) to 33 (29–41) (P<0.01). After CPB the LPR decreased to 4 (3–7) at the end of observation (P<0.05). The pyruvate concentration showed an immediate increase from 34 (30–42) µM at the end of CPB to 181 (147–234) µM after removal of the cross-clamp with subsequent increase during reperfusion (P<0.01). Plasma lactate and pyruvate showed no essential changes during the study.

Conclusion

Using the microdialysis technique it was possible to analyze myocardial metabolic changes during CABG. The course of myocardial LPR as a sensitive indicator of the myocardial redox state showed profound changes during and after CPB. We propose the microdialysis technique as an additional monitoring tool in CABG.

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Authors and Affiliations

  1. Department of Anesthesiology, Medical University of Lübeck, Ratzeburger Allee 160, 23538 , Lübeck, Germany

    Ludger Bahlmann, Stephan Klaus, Alexander Leptien, Matthias Heringlake & Peter Schmucker

  2. Department of Cardiac Surgery, Medical University of Lübeck, Lübeck, Germany

    Martin Misfeld, Hans-Hinrich Sievers & Ernst-Guenther Kraatz

  3. Department of Pharmacology, Karolinska Institute, Stockholm, Sweden

    Urban Ungerstedt

Authors
  1. Ludger Bahlmann
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  2. Martin Misfeld
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  3. Stephan Klaus
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  4. Alexander Leptien
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  5. Matthias Heringlake
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  6. Peter Schmucker
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  7. Hans-Hinrich Sievers
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  8. Urban Ungerstedt
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  9. Ernst-Guenther Kraatz
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Correspondence to Ludger Bahlmann.

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Bahlmann, L., Misfeld, M., Klaus, S. et al. Myocardial redox state during coronary artery bypass grafting assessed with microdialysis. Intensive Care Med 30, 889–894 (2004). https://doi.org/10.1007/s00134-004-2199-3

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  • DOI: https://doi.org/10.1007/s00134-004-2199-3

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