Pyruvate-Enhanced Resuscitation for Hemorrhagic Shock and Hindlimb Ischemia.

摘要

The overall goals of this investigation were to test the ability of pyruvate to protect the heart during cardiopulmonary bypass and, thus, hasten recovery of cardiac function post-bypass, and to delineate the mechanisms of pyruvate's salutary effects. To accomplish these goals, the following specific aims were addressed in patients undergoing elective coronary artery revascularization on cardiopulmonary bypass (Specific aim 1) and in in situ swine hearts subjected to cardioplegic arrest (Specific aims 2-4): Specific aim 1: Test whether the use of pyruvate-fortified cardioplegia to arrest the heart during bypass surgery hastens post-surgical recovery of cardiac contractile performance and minimizes myocardial injury relative to pyruvate-free solutions. Specific aim 2: Assess the ability of lactate- and pyruvate-fortified cardioplegia solutions to dampen oxyradical formation and bolster endogenous antioxidant defenses during cardioplegic arrest. Specific Aim 3: To test the ability of lactate- and pyruvate-fortified cardioplegia solutions to preserve myocardial energetics during cardioplegic arrest. Specific Aim 4: To determine whether pyruvate administration at the time of myocardial reperfusion following cardioplegic arrest restores myocardial energy state, antioxidant defenses, and prevents oxyradical inactivation of metabolic enzymes.