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Chapter 11 - Myocardial Preservation during Cardiopulmonary Bypass

Published online by Cambridge University Press:  24 October 2022

By
Gudrun Kunst ,
Luc Puis  and
Tom Gilbey
Edited by
Florian Falter ,
Albert C. Perrino, Jr  and
Robert A. Baker
Florian Falter
Affiliation:
Royal Papworth Hospital, Cambridge
Albert C. Perrino, Jr
Affiliation:
Yale University Medical Center, Connecticut
Robert A. Baker
Affiliation:
Flinders Medical Centre, Adelaide
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Summary

Avoiding unnecessary myocardial damage has been at the forefront of cardiac surgery since its early days. The ability to arrest and immobilize the heart and revive it again without loss of function has facilitated more and more complex surgeries. Effective myocardial protection, particularly for the duration of aortic cross clamping, involves multimodal strategies consisting of temperature management, cardioplegic solutions delivered by various routes as well as non-cardioplegic techniques like ischemic preconditioning through intermittent cross-clamping or pharmacological protection.

Keywords

Ischemia-Reperfusion InjuryCardioplegiaIntracellular Cardioplegia SolutionsExtracellular Cardioplegia SolutionsCardioplegia Delivery SystemsTemperature ManagementNon-Cardioplegic Myocardial Protection
Type
Chapter
Information
Cardiopulmonary Bypass , pp. 102 - 111
Publisher: Cambridge University Press
Print publication year: 2022

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References

Suggested Further Reading

Yellon, DM, Hausenloy, DJ. Myocardial reperfusion injury. N Engl J Med. 2007; 357: 1121–1135CrossRefGoogle ScholarPubMed
Xia, Z, Li, H, Irwin, MG. Myocardial ischaemia reperfusion injury: the challenge of translating ischaemic and anaesthetic protection from animal models to humans. Br J Anaesth. 2016; 117: ii44–ii62CrossRefGoogle ScholarPubMed
Davidson, SM, Andreadou, I, Garcia-Dorado, D et al. Shining the spotlight on cardioprotection: beyond the cardiomyocyte. Cardiovasc Res. 2019; 115: 1115–1116Google Scholar
Kunst, G, Klein, AA. Peri-operative anaesthetic myocardial preconditioning and protection – cellular mechanisms and clinical relevance in cardiac anaesthesia. Anaesthesia. 2015; 70: 467–482CrossRefGoogle ScholarPubMed
Buckberg, GD. Update of current techniques of myocardial protection. Ann Thorac Surg 1995; 60: 805–814CrossRefGoogle ScholarPubMed
Spellman, J. Pro: in favor of more generalized use of del Nido cardioplegia in adult patients undergoing cardiac surgery. J Cardiothor Vasc Anesth 2019; 33: 1785–1790Google Scholar
Gorgy, A, Shore-Lesserson, L. Del Nido cardioplegia should be ssed in all adults undergoing cardiac surgery: con. J Cardiothor Vasc Anesth. 2019; 33: 1791–1794CrossRefGoogle Scholar
Salerno, TA, Ricci, M, eds. Myocardial Protection. First edition. Oxford: Blackwell Publishing Ltd. 2004Google Scholar
Ali, JM, Miles, LF, Abu-Omar, Y et al. Global cardioplegia practices: results from the Global Cardiopulmonary Bypass Survey. J Extra Corpor Technol. 2018; 50: 83–93CrossRefGoogle ScholarPubMed
Murry, CE, Jennings, RB, Reimer, KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation. 1986; 74: 1124–1136Google Scholar

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