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Myocardial protection during cardiac surgery 

Myocardial protection during cardiac surgery
Chapter:
Myocardial protection during cardiac surgery
Author(s):

Michael G. Irwin

and Gordon Tin Chun Wong

DOI:
10.1093/med/9780199653478.003.0015
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date: 13 October 2019

Cardiac muscle invariably sustains a degree of injury when subjected to the rigors of surgical intervention and cardiopulmonary bypass. Much of this stems from ischaemia and subsequent reperfusion injury. As patients presenting for surgery are increasingly elderly with more co-morbidities, myocardial protection is particularly important in delivering good outcomes. This chapter provides a critical review of the various cardioprotective strategies used in this setting. It begins with an overview of the history of cardioprotection and then focuses specifically on cardioplegia-based techniques as well as other interventions. This is followed by a discussion of the more novel approaches of cardiac conditioning, whereby the myocardium is rendered more resistant to ischaemia by pharmacological or physical means, with an emphasis on the role of anaesthetic agents in achieving the conditioned state. The molecular mechanisms underlying cardiac conditioning will be outlined as well as the obstacles facing this exciting area of research development.

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