Myocardial protection: a forgotten modality.

Area of Science:

• Cardiology
• Cardiac Surgery
• Cardiovascular Research

Background:

• Myocardial protection is essential in cardiac surgery for both technical success and preserving heart function.
• Current cardioplegic techniques may still result in myocardial damage, evidenced by common postoperative septal dysfunction and need for hemodynamic support.
• Despite its importance, myocardial protection is infrequently discussed in recent literature and major meetings.

Purpose of the Study:

• To highlight the critical role of myocardial protection in cardiac surgery.
• To identify cardiac enzymes and septal function as key indicators of myocardial protection adequacy.
• To review available cardioplegic techniques for optimal cardiac protection.

Main Methods:

• Analysis of cardiac enzymes and septal function as markers for myocardial protection.
• Review of existing literature on myocardial protection strategies in cardiac surgery.
• Discussion of the consequences of inadequate myocardial protection, including septal dysfunction and mortality.

Main Results:

• Cardiac enzymes and septal function are proposed as ideal markers for assessing myocardial protection.
• Postoperative septal dysfunction or elevated cardiac enzymes, occurring in 40-80% of patients, are linked to inadequate protection.
• These issues correlate significantly with both early and late mortality after cardiac surgery.

Conclusions:

• Inadequate myocardial protection during cardiac surgery remains prevalent and has serious consequences.
• Monitoring cardiac enzymes and septal function is vital for evaluating protection effectiveness.
• Understanding and critically assessing cardioplegic methods are necessary for optimizing patient outcomes.