Metabolic interventions in myocardial preservation

It is possible to manipulate myocardial metabolism to improve recovery after ischaemic insults. We studied 2 metabolic manipulations: addition of amino acids during cardioplegia, and treatment with orotic acid before cardioplegia. Aspartate improved recovery after cardioplegic arrest, and glutamate exerted a minimal protective effect. We studied the recently infarcted heart to determine whether orotic acid therapy could improve recovery after cardioplegia. The infarct placed the non-infarcted myocardium under stress and increased its sensitivity to hypothermic cardioplegia. This sensitivity was reduced by treatment with orotic acid. Metabolic supplementation may be useful during cardiac surgery, after myocardial infarction, and in the early period after cardiac surgery.