Optimal myocardial preservation: cooling, cardioplegia, and conditioning.
Myocardial preservation techniques have evolved in conjunction with cardiac surgery and currently offer substantial protection against myocardial injury. We propose that cardiac preconditioning, a robust, endogenous mechanism of cardioprotection, is emerging as an important adjunct to current cardioplegic techniques. By reviewing the physiologic basis for current cardioplegic strategies, and understanding the cardioprotective benefits of preconditioning, we postulate that cardiac preconditioning may represent an important, clinically accessible component of myocardial protection.
Cleveland
J C
JC
Department of Surgery, University of Colorado Health Sciences Center, Denver 80262, USA.
Meldrum
D R
DR
Rowland
R T
RT
Banerjee
A
A
Harken
A H
AH
D000818:Animals; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004734:Energy Metabolism / Q000502:physiology; D006321:Heart; D006324:Heart Arrest, Induced / Q000379:methods; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D007036:Hypothermia, Induced; D007430:Intraoperative Care; D017202:Myocardial Ischemia / Q000517:prevention & control*; D009206:Myocardium / Q000378:metabolism; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion / Q000379:methods