Intraoperative myocardial protection: current trends and future perspectives

Area of Science:

• Cardiovascular Surgery
• Cardiothoracic Anesthesia
• Myocardial Protection

Background:

• Coronary artery bypass graft (CABG) surgery outcomes are excellent but require minimizing perioperative risks.
• Evolving patient demographics necessitate advanced strategies for reducing morbidity and mortality.

Purpose of the Study:

• To review current and novel cardioplegic strategies used at Toronto Hospital.
• To evaluate future clinical applications of innovative cardioplegic formulations.

Main Methods:

• Review of cardioplegic techniques developed and employed at Toronto Hospital.
• Evaluation of novel cardioplegic formulations for potential clinical use.

Main Results:

• Blood cardioplegia offers superior protection compared to crystalloid.
• Warm blood cardioplegia repleted adenosine triphosphate (ATP) and improved function.
• Tepid cardioplegia (29°C) reduced metabolic byproducts and improved function.
• Combined antegrade/retrograde delivery and adequate flow (≥200 mL/min) enhanced metabolic recovery.
• Adenosine, insulin, and L-arginine show promise for enhanced myocardial protection.

Conclusions:

• Low output syndrome post-high-risk CABG persists despite advancements.
• Novel cardioplegic additives offer potential for improved myocardial protection.
• Further development may reduce morbidity and mortality in CABG patients.