Controlled hyperkalemic reperfusion with magnesium rescues ischemic juvenile hearts by reducing calcium loading.

Objectives: Our objectives were (1) to determine whether elevated Mg(2+) in controlled hyperkalemic reperfusate without intervention during ischemia protects the juvenile heart against reperfusion injury; and (2) to identify the mechanism(s) underlying any protective effect of Mg(2+). Methods: Langendorff-perfused hearts from juvenile (11- to 14-day-old) guinea pigs were subjected to mild (30-minute) or severe (45-minute) normothermic global ischemia and 35-minute reperfusion. Hearts were subjected to controlled hyperkalemic reperfusion without or with various concentrations of Mg(2+) (5, 10, 16, 23 mM). The mechanisms underlying the effect of Mg(2+) on intracellular Ca(2+) ([Ca(2+)] i) were also studied in isolated cardiomyocytes exposed to metabolic inhibition followed by washout using hyperkalemic solutions (reperfusion). Results: Sixteen mM Mg(2+) conferred maximal cardioprotection as assessed by improved functional recovery and reduced cardiac injury; this was associated with a significant recovery of cardiac energetics and metabolism following both mild and severe ischemia. The Mg(2+)-induced protection was additive to that of hyperkalemia following mild ischemia and conferred protection following severe ischemia when hyperkalemia alone had no significant effect. Elevated Mg(2+) in the hyperkalemic reperfusate of cardiomyocytes acutely prevented [Ca(2+)] i loading following mild metabolic inhibition and augmented the fall in [Ca(2+)] i following severe metabolic inhibition. Conclusions: This work demonstrates for the first time in juvenile hearts that elevated Mg(2+) during controlled hyperkalemic reperfusion rescues the heart following ischemia, and that this is likely to be facilitated by reducing [Ca(2+)] i which, in turn, would aid metabolic recovery. (J Thorac Cardiovasc Surg 2011;141:1529-37)