Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Myocardial protection during reconstructive surgery for complicated forms of ischemic heart disease

Authors: Zakargaev R.K., Alshibaya M.D.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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DOI: https://doi.org/10.24022/1814-6910-2022-19-2-104-108

UDC: 616.12-008.46-089

Link: Clinical Physiology of Blood Circulaiton. 2022; 2 (19): 104-108

Quote as: Zakargaev R.K., Alshibaya M.D. Myocardial protection during reconstructive surgery for complicated forms of ischemic heart disease. Clinical Physiology of Circulation. 2022; 19 (2): 104–8 (in Russ.). DOI: 10.24022/1814-6910-2022-19-2-104-108

Received / Accepted:  03.12.2021 / 30.01.2022

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Abstract

The history of cardioplegia began in 1955, when D. Melrose presented the first experimental study describing cardiac arrest by injecting a special blood-based hyperkalium solution into the aortic root, called “cardioplegia”. But due to the high content of potassium citrate in Melrose solution (up to 245 meq/l), contractional necrosis of the myocardium occurred, which led to ventricular fibrillation and further death. Meanwhile, W. Gay and P. Ebert demonstrated the safety of cardioplegia with reduced potassium concentration. Authors also suggested that the negative result of the Melrose solution was due to the hyperosmolarity of the solution, and not the high concentration of potassium.

The advantages of a stopped heart surgery became obvious and there was a need to develop and introduce into clinical practice methods of cardioprotection during the absence of coronary blood flow. Today the method of cardiac arrest is cardioplegia with chemical agents. From that moment, researchers began to develop the methods of myocardial protection. In a broad sense, the concept of “myocardial protection” includes a whole range of methods, including adequate anesthesia, surgical techniques, artificial blood circulation, and cardioplegia.

The method of intraoperative myocardial protection in patients with initially compromised myocardium is of particular importance. This group includes patients with large postinfarction aneurysms of the left ventricle (LV), reduced LV ejection fraction and severe multiple lesions of the coronary arteries. Even minor damage to the myocardium due to its inadequate protection can be decisive in the outcome of the patient's treatment.

About Authors

  • Rashid K. Zakargaev, Postgraduate; ORCID
  • Mikhail D. Alshibaya, Dr. Med. Sci., Professor, Head of Department of Surgical Treatment of Coronary Heart Disease; ORCID

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