Update on current techniques of myocardial protection

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The spectrum of strategies for myocardial protection has led to the artificial creation of adversarial positions in regard to warm versus cold blood cardioplegia, antegrade versus retrograde delivery, and intermittent versus continuous perfusion. This report reviews the background for the aforementioned methods, that has led to the evolution of an integrated myocardial management technique that combines the advantages of the aforementioned methods to compensate for their individual shortcomings. This approach coordinates the myocardial protective strategies with the continuity of the operation so that the surgical procedure is never interrupted. It provides unimpaired vision, avoids unnecessary ischemia and cardioplegic overdose, allows aortic clamping as soon as cardiopulmonary bypass is started, permits aortic unclamping and discontinuation of bypass shortly after the technical procedure is completed, and minimizes the ration of ischemia and cardiopulmonary bypass. The preliminary results in 1,474 patients from four centers with surgeons participating in the infrastructure of this method are presented.

References (53)

  • BeyersdorfF et al.

    Warm glutamate/aspartate-enriched blood cardioplegic solution for perioperative sudden death

    J Thorac Cardiovasc Surg

    (1992)
  • LazarHL et al.

    Myocardial energy replenishment and reversal of ischemic damage by substrate enhancement of secondary blood cardioplegia with amino acids during reperfusion

    J Thorac Cardiovasc Surg

    (1980)
  • BuckbergGD et al.

    Studies of the effects of hypothermia on regional myocardial blood flow and metabolism during cardiopulmonary bypass. I. The adequately perfused beating, fibrillating and arrested heart

    J Thorac Cardiovasc Surg

    (1977)
  • TeohKH et al.

    Accelerated myocardial metabolic recovery with terminal warm blood cardioplegia

    J Thorac Cardiovasc Surg

    (1986)
  • KirklinJW

    Technical and scientific advances in cardiac surgery over the past 25 years

    Ann Thorac Surg

    (1990)
  • DrinkwaterDCJ et al.

    The use of combined antegrade-retrograde infusion of blood cardioplegic solution in pediatric patients undergoing heart operation

    J Thorac Cardiovasc Surg

    (1992)
  • PartingtonMT et al.

    Studies of retrograde cardioplegia. I. Capillary blood flow distribution to myocardium supplied by open and occluded arteries

    J Thorac Cardiovasc Surg

    (1989)
  • SalernoTA et al.

    Retrograde continuous warm blood cardioplegia: a new concept in myocardial protection

    Ann Thorac Surg

    (1991)
  • HottenrottCE et al.

    The hazard of ventricular fibrillation in hypertrophied ventricles during cardiopulmonary bypass

    J Thorac Cardiovasc Surg

    (1973)
  • HottenrottC et al.

    Studies of the effects of ventricular fibrillation on the adequacy of regional myocardial flow. III. Mechanism of ischemia

    J Thorac Cardiovasc Surg

    (1974)
  • WareingTH et al.

    Strategy for the reduction of stroke incidence in cardiac surgical patients

    Ann Thorac Surg

    (1993)
  • LoopFD et al.

    Myocardial protection during cardiac operations

    J Thorac Cardiovasc Surg

    (1992)
  • ArankiSF et al.

    Single-clamp technique: an important adjunct to myocardial and cerebral protection in coronary operations

    Ann Thorac Surg

    (1994)
  • BuckbergGD et al.

    Use of hypocalcemic blood cardioplegia with clear extracorporeal primes containing albumin

    J Thorac Cardiovasc Surg

    (1994)
  • ShikiK et al.

    Myocardial distribution of retrograde flow through the coronary sinus of the excised normal canine heart

    Ann Thorac Surg

    (1986)
  • StirlingMC et al.

    Distribution of cardioplegic solution infused antegradely and retrogradely in normal canine hearts

    J Thorac Cardiovasc Surg

    (1989)
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    Presented at the International Symposium on Myocardial Protection From Surgical Ischemic-Reperfusion Injury, Asheville, NC, Sep 25ā€“28, 1994.

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