Might myocardial protection be achieved by advanced perfusion with an anoxic acidic buffer?
• Richard G Fiddian-Green, FRCS, FACS None Dear Editor, These studies do not exclude the possibility that myocardial protection might be induced independently of K+(atp) changes by priming the protonmotive force needed to drive ATP resynthesis by oxidative phosphorylation [1]. It could be an important consideration for the protonmotive force might be more easily and reliably primed in advance of angioplasty by perfusing the occluded vessel being targeted with an acidic buffer than by occluding the coronary artery for a limited period. Indeed the failure to have demonstrated myocardial protection in this study might have been due to the failure of coronary artery occlusion to have had a consisent and even an appreciable effect upon the intramyocardial pH and the K+(atp) channel opening with which a fall in pH may be associated. Functional recovery was better in neonatal rabbit hearts perfused with an acidic buffered cardioplegic solution than those perfused with a basic buffered cardiop
