Influence of the pH of cardioplegic solutions on intracellular pH, high-energy phosphates, and postarrest performance. Protective effects of acidotic, glutamate-containing cardioplegic perfusates.

The common practice of using alkalotic cardioplegic solutions is not supported by experimental evidence. The present study was conducted to assess the effects of varying the pH (7.00, 7.40, and 7.70 at 20 degrees C) of a glutamate-containing cardioplegic solution on intracellular pH, high-energy phosphate content, and postarrest functional recovery and to compare the effects of various buffers (glutamate, bicarbonate, TRIS, and histidine) at a given pH (7.00 and 7.40). Isolated perfused rat hearts were subjected to 2 hours of cardioplegic arrest at 15 degrees C followed by 30 minutes of reperfusion. Intracellular pH and high-energy phosphate content were measured at 4 minute intervals by phosphorus 31 nuclear magnetic resonance spectroscopy. These data were correlated with postischemic recovery of function. There was no significant difference between the intracellular pH values recorded at the end of arrest in the three glutamate-containing groups. However, the acidotic solution (pH 7.00) resulted in better preservation than the alkalotic solution (pH 7.70), as evidenced by a higher creatine phosphate content at the end of arrest (61% +/- 9% of control values versus 30% +/- 9% [mean +/- standard error of the mean], p less than 0.05), a higher adenosine triphosphate content at the end of reperfusion (102% +/- 5% versus 82% +/- 6%, p less than 0.05), and a faster recovery of aortic flow (at 3 minutes of reperfusion, 91% +/- 11% versus 51% +/- 11%, p less than 0.05). Subsequent comparison of buffers showed that bicarbonate, TRIS, and histidine were equally effective in maintaining intracellular pH close to control values during arrest. Conversely, the use of glutamate resulted in a more pronounced fall in intracellular pH, which correlated with a better preservation of adenosine triphosphate and a better functional recovery than in the other groups. Overall, the greatest extent of preservation was provided by the pH 7.00 glutamate-containing cardioplegic solution. We conclude that additional protection can be conferred to the cold, chemically arrested heart by combining mild intracellular acidosis, which lowers metabolic needs during arrest, most likely through a limitation of calcium overload, and provision of glutamate, which may act as a substrate for anaerobic energy production while allowing intracellular pH to be kept within the appropriate range.