EVALUATION OF THE ROLE OF BLOOD CARDIOPLEGIA IN MYOCARDIAL PROTECTION DURING OPEN HEART SURGERY

Abstract

The , cardioprotective strategies available for intraoperative myocardial protection are numerous. Crystalloid versus blood, antegrade versus retrograde or combined antegrade/ retrograde delivery, warm versus cold and intermittent versus continuous perfusion are the main methods currently used.

Myocardial protection was initially achieved using cold crystalloid cardioplegia, however after Buckberg et al introduced the concept of blood as the basis for cardioplegia, there has been an increase in the use of blood based cardioplegic solutions, not only in the USA, but also jn Europe and the UK. Over this period, a number . of studies, both experimental and clinical have suggested the superiority of blood cardioplegia over crystalloid one. Blood cardioplegia has been used extensively on the belief that recovery can be imP,roved by increased oxygen carriage and the presence of the oncotic activity of plasma \ proteins liiniting the extent of interstitial edema. Moreover, much more

benefits can be obtained from the use of blood in cardioplegia through the much greater buffering capacity, the provision of tricarboxylic acid c:ycle substrates and the presence of catalase systems which are abundant in n!d blood cells.