Chapter category: Heart
The Cellular Basis of Immediate Lethal Reperfusion Injury
Ischemia-Reperfusion Injury in Cardiac Surgery
Edited by: Friedhelm BeyersdorfISBN: 1-58706-002-7
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Chapter authors:
H. M. Piper and D. García-Dorado
In cardiac surgery, myocardium may suffer from ischemia either because it has been ischemic prior to the surgical intervention or because it is made intentionally or becomes inadvertently ischemic during the intervention. As a result of a successful revascularization or the end of the surgical manipulations, the ischemic myocardium may be reperfused. Ischemic or postischemic loss of viable myocardium is one of the major foes impairing an improvement of cardiac function after cardiac surgery. Many procedures have been designed for the purpose to protect myocardium against ischemic injury. The possibility—and need—to protect myocardium during the first minutes to hours of reperfusion against "reperfusion injury" has been largely neglected. This may seem surprising as the cardiac surgeon can control precisely the conditions of reperfusion. This chapter is focussed on the possibilities of protecting myocardial cells from cell death specifically by modifying the early conditions of reperfusion, i.e., to protect against the early causes of lethal reperfusion injury. It describes the novel strategies developed during the past decade in experimental research. The chapter does not deal with two other closely related topics which have been discussed extensively in several other recent reviews. These are: reversible postischemic dysfunction, so-called stunning, and delayed causes of lethal reperfusion injury, e.g., by activation of blood-borne factors.
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