Chapter category: Heart
Cold/Tepid Cardioplegia
Ischemia-Reperfusion Injury in Cardiac Surgery
Edited by: Friedhelm BeyersdorfISBN: 1-58706-002-7
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Chapter authors:
Hendrick B. Barner and Andrew C. Fiore
Hypothermia has been an essential component of myocardial protection for cardiac operations since the beginning.1 The evolution of cardioplegia from crystalloid solutions of intracellular composition to those of extracellular composition and finally to blood based solutions has had the common theme of cardiac and systemic hypothermia.2
The focus of many investigators has been that of reducing myocardial metabolism to the lowest possible level during the ischemic interval so that myocardial energy stores (adenosine triphosphate and glycogen) are maintained and tissue acidosis is avoided during the ischemic interval. Myocardial oxygen consumption of the working heart is 1012 ml/100 g/min and of the nonworking vented heart 6-8 ml/100 g/min.3 The potassium paralyzed heart has a myocardial oxygen consumption of 0.31 ml/100 g/min at 22½C3 which is reduced to 0.135 ml/100 g/min at 10-12½C.4
Additional chapters from this book:
Protection Strategies for Heart Transplantation
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Interrupting Warm Blood Cardioplegia
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Warm blood cardioplegia has emerged as an alternative method of myocardial protection. Initial retrospective clinical studies using warm blood techniques showed good myocardial protection; how...
Surgical Techniques for Warm Blood Cardioplegia
Syed T. Raza and Tomas A. Salerno
Hypothermic techniques of myocardial preservation (crystalloid or blood cardioplegia) have been utilized in recent years and represent an important development in cardiac surge...
Cold/Tepid Cardioplegia
Hendrick B. Barner and Andrew C. Fiore
Hypothermia has been an essential component of myocardial protection for cardiac operations since the beginning.1 The evolution of cardioplegia from crystalloid solutions of intr...
Intravenous Metabolic Support with GIK (Glucose-Insulin-Potassium) and Amino
Rolf Svedjeholm
Myocardial preservation in cardiac surgery has evolved rapidly during the last decades. Some authors of this book have made major contributions to this development. A variety of methods to pro...
Away from Ischemic Preconditioning and Towards Pharmacological Preconditioning
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Endogenous myocardial protection refers to the natural defense mechanisms available to the heart to withstand an ischemic injury. So far these mechanisms have been shown to encompass two pheno...
Ischemic Preconditioning - from Bench to Bedside
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Günter Steurer, Katharina Palisek and Werner Mohl
Enormous advances in surgical, pharmacological, and interventional techniques resulting in early restoration of infarct artery patency significantly improved outcome in patients with acute cor...
Metabolic and Antioxidant Support with Amino Acids
Oleg I. Pisarenko
Hypothermic hyperkalemic cardiople- giais is currently the preferred method of myocardial preservation for the performance of cardiac operations. At present research efforts of many laboratori...
Metabolic Support for the Heart During Ischemia and Reperfusion: Role of Amino Acids
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In reviewing amino acid metabolism of the heart during ischemia and reperfusion it is important to address a few principles of energy substrate metabolism first. The healthy human heart has a ...
Sodium-Proton Exchange Inhibition as a Novel Strategy for Myocardial Protection
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Ongoing developments in cardiac surgery, like surgery on the beating, warm heart in minimal invasive coronary bypass grafting, the increasing incidence of cardiac surgery in the elderly as wel...
The NO-Donor L-Arginine Reduces the Reperfusion Injury after Heart Transplantation
Gábór Szabó
Ischemia-reperfusion injury is a common condition during cardiac surgery. Myocardial performance within the first hours after the surgical procedure determines the patient's state not only dur...
Changes in Myocardial Gene Expression Following Ischemia and Reperfusion
John W. C. Entwistle III and Andrew S. Wechsler
The heart has the remarkable ability to adapt to a wide variety of physiological and pathological conditions. Some examples of change in the structure and function of the heart include normal ...
Apoptosis in Ischemia - Reperfusion Injury
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Apoptosis or "programmed cell death" has recently been recognized to be involved in several cardiovascular diseases. There are some histologic criteria as well as histochemical, bioc...
The Cellular Basis of Immediate Lethal Reperfusion Injury
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 isch...
Harnessing the Cardioprotective Potential of Nitric Oxide in Nonsurgical and Surgical Ischemic-Reperfusion Injury
Jakob Vinten-Johansen Russell S. Ronson
In cardiac surgery, there are numerous opportunities during the conduct of the operation for both unplanned and hence unprotected ischemia with subsequent reperfusion. These periods of potenti...
