Beta-blockade as an alternative to cardioplegia

As an alternative to cardioplegic arrest, "cardiac surgical conditions" (i.e. a flaccid heart which facilitates surgery) have been created by continuously perfusing the coronary arteries with normothermic blood and suppressing myocardial chronotropy and inotropy with the ultra-short acting beta-blocker esmolol. In contrast to cardioplegic arrest, minimal cardiac contraction is maintained. Using this technique, the myocardium is protected against ischemia by antegrade coronary blood flow and reduced metabolism. In addition, the presence of minimal cardiac contractions protects the myocardium against edema formation by maintaining myocardial fluid balance. This paper presents both the rationale for and the application of "beta-blocker-induced cardiac surgical conditions" as an alternative concept for myocardial protection during coronary artery surgery.