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

E-mail: Сведения доступны для зарегистрированных пользователей.

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.

References

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  1. Hale S.L., Kloner R.A. Miocardial hypothermia: a potential therapeutic technique for acute regional myocardial ischemia. J. Cardiovasc. Electrophsyiol. 1999; 10 (3): 405–13.
  2. Singer D., Bretschneider H.J. Metabolic reduction in hypotermia: patophysiological problems and natural examples (Part 1+2). J. Thorac. Cardiovasc. Surg. 1990; 38: 205–19.
  3. Wang J., Liu H., Salerno T.A., Tomanek B., Summers R., Deslauriers R., Arora R.C. Alternate antegrade/retrograde perfusion: an effective technique to preserve hypertrophied hearts during valvular surgery. Eur. J. Cardiothorac. Surg. 2009; 35 (1): 69–76. DOI: 10.1016/j.ejcts.2008.10.015
  4. Garlade J., Davierwala P., Seeburger J. Myocardial protection during minimally invasive mitral valve surgery: strategies and cardioplegic solutions. Ann. Cardiothorac. Surg. 2013; 2 (6). DOI: 10.3978/j.issn.2225-319X.2013.09.04
  5. Günday M., Bingöl H. Is crystalloid cardioplegia a strong predictor of intra-operative hemodilution? J. Cardiothorac. Surg. 2014; 9: 23. DOI: 10.1186/1749-8090-9-23
  6. Prathanee S., Kuptanond C., Intanoo W. CustodiolHTK solution for myocardial protection in CABGE patients. J. Med. Assoc. Thai. 2015; 7: 164.
  7. Lichtenstein S.V., El Dalati Н., Panos A., Slutsky A.S. Long cross-clamp time with warm heard surgery. Lancet. 1989; 1 (8806): 1383–4.
  8. Zeriouh M., Heider A., Rahmanian P.B., Yeong-Hoon Choi, Sabashikov A., Scherner M. et al. Six-years survival and predictors of mortality after CABG using cold vs warm blood cardioplegis in elective and emergent settings. J. Cardiothorac. Surg. 2015; 10: 384–9. DOI: 10.1186/s13019-015-0384-9
  9. Sher-I-Murtaza M., Ali Rizvi H.M., Raza Baig M.A. Myocardial protection with multiport ntergrade cold blood cardioplegia and continuous controlled warm shot through vein grafts during proximal ends anastomosis in conventional coronary artery bypass graft. J. Pak. Med. Assoc. 2016; 66 (1): 53–8.
  10. Tulner S.A., Klautz R.J., Engbergs F.H. Left ventricular function and chronotropic responses after normotermic cardiopulmonary bypass with intermittent antergrade warm blood cardioplegia in patients undergoin coronary artery bypass grafting. Eur. J. Cardiothorac. Surg. 2005; 27: 599–605. DOI: 10.1016/j.ejcts.2004.11.024
  11. Bockeria L.А., Volgushev V.Ye., Movsesyan R.R., Aibazov R.U., Berishuili I.I., Sigayev I.Yu. Use of normothermal cardioplegic solution at myocardial revascularization surgery. Russian Journal of Thoracic and Cardiovascular Surgery. 2006; 3: 4–8 (in Russ.).
  12. De Jonge M., van Boxtel A.G., Soliman Hamad M.A., Mokhles M.M., Bramer S., Osnabrugge R.L.G. et al. Intermittent warm blood versus cold crystalloid cardioplegia for myocardial protection: a propensity scorematched analysis of 12-year single-center experience. Perfusion. 2015; 30 (3): 243–9. DOI: 10.1177/0267659114540023
  13. Zeng J., He W., Qu Z. Cold blood versus crystalloid cardioplegia for myocardial protection in adult cardiac surgery: a meta-analysis of randomized controlled studies. J. Cardiothorac. Vasc. Anesth. 2014; 28 (3): 674–81. DOI: 10.1053/j.jvca.2013.06.005

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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