Perioperative Myocardial Protection during Cardiac Surgery
Mohamed Ibrahim Abdelwahab Ibrahim;
Abstract
Optimal results in cardiac surgery not only require a rapid and perfect surgical repair, but also prevention of myocardial damage and maintenance of normal cellular integrity especially during CPB.
The term "myocardial protection" refers to strategies and methodologiesused either to attenuate or to prevent post-ischemic myocardialdysfunction that occurs during and after heart surgery
Hyperkalemic cardioplegic solutions have been proposed as an improved method for myocardial protection during CABG surgery. The reduction in mortality and morbidity associated with the use of hyperkalemic cardioplegic solutions was attributed to the prevention of myocardial oxidative stress. However, hyperkalemic cardioplegia utilizes potassium as the only additive. This arrests the heart by partially depolarizing the cardiac myocyte membrane but at the same time it may facilitate opening of calcium channels with the direct result of calcium loading and therefore potential cellular damage.
Based on the experiencewith current cardioplegic techniques we can conclude that bloodfrom cardioplegic solutions appears superior to crystalloid cardioplegiain terms of myocardial protection.
Preconditioning is activated by brief ischemic insults separated by short reperfusion intervals applied prior to long ischemia and there is ample evidence that preconditioning exists in humans and reduces infarct size.
Both pre- and postconditioning may share some common pathways, which include several common intracellular mediators however; Postconditioning seems to be superior being more feasible in clinical practice, it is proved the presence of cardioprotective role of inhalational anesthetic
Our patient’s vulnerability to injury has increased, so we need to improve our methods of protection as well as learn new operative techniques. Thus, in the near future, any furthermeasures in myocardial protection will be necessary to improve current techniques that are not completely adequate in high-riskclinical settings.
The term "myocardial protection" refers to strategies and methodologiesused either to attenuate or to prevent post-ischemic myocardialdysfunction that occurs during and after heart surgery
Hyperkalemic cardioplegic solutions have been proposed as an improved method for myocardial protection during CABG surgery. The reduction in mortality and morbidity associated with the use of hyperkalemic cardioplegic solutions was attributed to the prevention of myocardial oxidative stress. However, hyperkalemic cardioplegia utilizes potassium as the only additive. This arrests the heart by partially depolarizing the cardiac myocyte membrane but at the same time it may facilitate opening of calcium channels with the direct result of calcium loading and therefore potential cellular damage.
Based on the experiencewith current cardioplegic techniques we can conclude that bloodfrom cardioplegic solutions appears superior to crystalloid cardioplegiain terms of myocardial protection.
Preconditioning is activated by brief ischemic insults separated by short reperfusion intervals applied prior to long ischemia and there is ample evidence that preconditioning exists in humans and reduces infarct size.
Both pre- and postconditioning may share some common pathways, which include several common intracellular mediators however; Postconditioning seems to be superior being more feasible in clinical practice, it is proved the presence of cardioprotective role of inhalational anesthetic
Our patient’s vulnerability to injury has increased, so we need to improve our methods of protection as well as learn new operative techniques. Thus, in the near future, any furthermeasures in myocardial protection will be necessary to improve current techniques that are not completely adequate in high-riskclinical settings.
Other data
| Title | Perioperative Myocardial Protection during Cardiac Surgery | Other Titles | حماية عضلة القلب فيما حول عمليات جراحة القلب | Authors | Mohamed Ibrahim Abdelwahab Ibrahim | Issue Date | 2015 |
Attached Files
| File | Size | Format | |
|---|---|---|---|
| G11858.pdf | 886.1 kB | Adobe PDF | View/Open |
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