Journal
PERFUSION-UK
Volume 36, Issue 4, Pages 338-351Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/0267659120942656
Keywords
myocardial protection; cardioplegia; cardiac arrest; cold blood; open heart
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Myocardial protection is crucial for successful recovery in patients undergoing cardiopulmonary bypass, and various techniques have been developed over the years. Each method has its own advantages and disadvantages, making it challenging to establish a gold-standard cardioplegic solution. This review aims to provide a comprehensive overview of different cardioplegic techniques and propose novel approaches for optimizing myocardial protection in the future.
For patients undergoing cardiopulmonary bypass, myocardial protection is a key for successful recovery and improved outcomes following cardiac surgery that requires cardiac arrest. Different solutions, components and modes of delivery have evolved over the last few decades to optimise myocardial protection. These include cold and warm and blood and crystalloid solution through antegrade, retrograde or combined cardioplegia delivery approach. However, each method has its own advantages and disadvantages, posing a challenge to establish a gold-standard cardioplegic solution with an optimised mode of delivery for enhanced myocardial protection during cardiac surgery. The aim of this review is to provide a brief history of the development of cardioplegia, explain the electrophysiological concepts behind myocardial protection in cardioplegia, analyse the current literature and summarise existing evidence that warrants the use of varying cardioplegic techniques. We provide a comprehensive and comparative overview of the effectiveness of each technique in achieving optimal cardioprotection and propose novel techniques for optimising myocardial protection in the future.
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