{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T18:09:48Z","timestamp":1789063788966,"version":"build-2803163510"},"reference-count":57,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"abstract":"<jats:p>\n                    Profound, transient hypotension refractory to \u03b1\n                    <jats:sub>1<\/jats:sub>\n                    -agonists and increased bypass flow during cardioplegia administration (intermittent vasoplegia) is a well-recognized yet unexplained phenomenon in cardiac surgery. Retrograde cardioplegia has been shown to cause profound hypotension with greater frequency than antegrade administration despite identical formulations, ischemic intervals, and perfusion parameters. It seems plausible that the link between cardioplegia administration to the arrested heart and the intermittent vasoplegic systemic response may result from a vagally mediated cardiac depressor reflex.\n                  <\/jats:p>\n                  <jats:p>Electrophysiologic and histologic studies have identified multiple vagal receptors within the ventricular myocardium and coronary vasculature that, when stimulated, produce a centrally mediated and prolonged withdrawal of efferent sympathetic activity to the systemic vasculature. During antegrade cardioplegia, hypotension most likely arises from activation of left ventricular chemoreceptors terminating in the inferoposterior wall. These afferents respond to endogenous mediators of ischemia and reperfusion such as bradykinin and prostaglandins.<\/jats:p>\n                  <jats:p>In contrast, the depressor reflex observed during retrograde cardioplegia likely arises from vagal afferent ventricular mechanoreceptors. In the arrested, decompressed heart, only 20\u201333% of retrograde cardioplegia traverses the capillaries, while the remainder is shunted through the Thebesian system. The resulting surge in coronary venous pressure causes distension that is easily transmitted to the surrounding interstitial space, creating the mechanical effects of grossly elevated end-diastolic pressure and pathological myocardial stretch despite the absence of true ventricular filling and wall tension.<\/jats:p>\n                  <jats:p>If the intermittent vasoplegic response to cardioplegia is viewed within the mechanistic framework of a vagally mediated depressor reflex, the optimal intervention to mitigate prolonged hypotension may not be stronger vasopressors (e.g., norepinephrine or vasopressin), but rather the inclusion of lidocaine in the microplegia additive. Lidocaine is known to markedly attenuate reflex vasodepressor responses through the blockade of sodium channels in nerve fibers.<\/jats:p>","DOI":"10.1177\/02676591261485080","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:12:41Z","timestamp":1788847961000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hypotension during cardioplegia: a cardiac depressor reflex?"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7399-047X","authenticated-orcid":false,"given":"Michael W.","family":"Vespe","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Division of Perfusion Services, Icahn School of Medicine at Mount Sinai"},{"name":"The Mount Sinai Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc E.","family":"Stone","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Division of Perfusion Services, Icahn School of Medicine at Mount Sinai"},{"name":"The Mount Sinai Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2025.07.011"},{"key":"e_1_3_3_3_2","first-page":"73","article-title":"Uber die physiologischen wirkungen des essigsauren veratrins","volume":"1","author":"von Bezold AV","year":"1867","unstructured":"von Bezold AV, Hirt L. Uber die physiologischen wirkungen des essigsauren veratrins. Unlersuchugen aus clem Physiologich Laboritorium Wurzburg 1867; 1: 73\u2013123.","journal-title":"Unlersuchugen aus clem Physiologich Laboritorium Wurzburg"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2001.tb03666.x"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.autneu.2024.103180"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01859921"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1964.sp007490"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(70)90596-5"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI107893"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.39.9.967"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1972.sp009751"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1113\/expphysiol.1988.sp003158"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1996.sp021765"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.53.3.490"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1113\/expphysiol.1986.sp003018"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7793.2000.00349.x"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7793.2001.0549f.x"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.67.4.796"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1253\/jcj.24.65"},{"key":"e_1_3_3_20_2","first-page":"289","article-title":"Two types of coronary vasomotor reflexes","volume":"47","author":"Szentivanyi M","year":"1962","unstructured":"Szentivanyi M, Juhasz-Nagy A. Two types of coronary vasomotor reflexes. Q J Exp Physiol Cogn Med Sci 1962; 47: 289\u2013298. https:\/\/doi.org\/10.1113\/expphysiol.1962.sp001611","journal-title":"Q J Exp Physiol Cogn Med Sci"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1965.sp007586"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1993.sp019972"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1993.sp019973"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1113\/expphysiol.1996.sp003944"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1966.sp007950"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1051\/ject\/200537306"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3565(25)05862-8"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7793.1998.633bk.x"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.46.4.476"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.74.5.904"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.2174\/157340309789317805"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajplegacy.1951.165.2.261"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1957.sp005750"},{"key":"e_1_3_3_34_2","first-page":"359","article-title":"The cardiovascular effects of coronary sinus distension in the anaesthetised dog","volume":"57","author":"Muers MF","year":"1972","unstructured":"Muers MF, Sleight P. The cardiovascular effects of coronary sinus distension in the anaesthetised dog. Q J Exp Physiol Cogn Med Sci 1972; 57: 359\u2013370. https:\/\/doi.org\/10.1113\/expphysiol.1972.sp002172","journal-title":"Q J Exp Physiol Cogn Med Sci"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1972.sp009752"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1965.sp007758"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-1716.1972.tb05247.x"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-1716.1972.tb05246.x"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-1716.1973.tb05429.x"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.40.4.415"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(76)90422-7"},{"key":"e_1_3_3_42_2","first-page":"267659123120601","article-title":"Is cardioplegia system pressure the optimal measure of coronary perfusion during antegrade cardioplegia delivery? A critical review of pressure measurements for optimal antegrade delivery","author":"Hacker A","year":"2023","unstructured":"Hacker A, Maggs P, Treanor P, et al. Is cardioplegia system pressure the optimal measure of coronary perfusion during antegrade cardioplegia delivery? A critical review of pressure measurements for optimal antegrade delivery. Perfusion 2023: 2676591231206016.","journal-title":"Perfusion"},{"key":"e_1_3_3_43_2","first-page":"497","volume-title":"Comprehensive Physiology","author":"Bishop VS","year":"2011","unstructured":"Bishop VS, Malliani A, Thor\u00e9n P. Cardiac mechanoreceptors. In: Terjung R (ed). Comprehensive Physiology. Wiley, 2011, pp. 497\u2013555."},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajplegacy.1967.212.6.1435"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(10)61712-2"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1002\/j.2040-4603.2017.tb00750.x"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(10)63522-9"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1152\/ajplegacy.1947.151.1.13"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(95)70195-8"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/0003-4975(93)90872-F"},{"key":"e_1_3_3_51_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-4-431-68087-1_6"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.1051\/ject\/2003352143"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)39212-8"},{"key":"e_1_3_3_54_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02086601"},{"key":"e_1_3_3_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(95)70320-9"},{"key":"e_1_3_3_56_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(94)70095-8"},{"key":"e_1_3_3_57_2","doi-asserted-by":"publisher","DOI":"10.1016\/0003-4975(94)91943-7"},{"key":"e_1_3_3_58_2","doi-asserted-by":"publisher","DOI":"10.1177\/0018578717738510"}],"container-title":["Perfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591261485080","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02676591261485080","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591261485080","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T17:54:42Z","timestamp":1789062882000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02676591261485080"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,7]]},"references-count":57,"alternative-id":["10.1177\/02676591261485080"],"URL":"https:\/\/doi.org\/10.1177\/02676591261485080","relation":{},"ISSN":["0267-6591","1477-111X"],"issn-type":[{"value":"0267-6591","type":"print"},{"value":"1477-111X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,7]]},"article-number":"02676591261485080"}}