The use of perfluorochemicals during open heart surgery

Several experimental studies of global myocardial ischemia involving different animal models have demonstrated enhanced oxygen delivery and oxygen consumption when oxygenated perfluorochemical cardioplegic solutions were used. Use of these solutions results in improved recovery of ventricular function after prolonged periods of global ischemia when compared with either standard crystalloid cardioplegic solutions or oxygenated blood cardioplegic solutions. Furthermore, intracellular pH and myocardial ATP levels are well maintained during protracted periods of global myocardial ischemia with oxygenated perfluorochemical cardioplegic solutions. Based on these convincing experimental results, clinical investigation of an oxygenated perfluorochemical cardioplegic solution is warranted. Although current methods of myocardial protection during open heart surgery usually are adequate, patients undergoing complicated open heart surgical procedures or those with significant left ventricular dysfunction prior to surgery--that is, those patients most in need of highly effective myocardial protection--would likely benefit substantially if oxygen were delivered via the cardioplegic solution. Furthermore, perfluorochemical solutions may be especially useful for cardiopulmonary bypass pump priming in patients unable to accept whole blood transfusion during open heart surgery.