Myocardial protection in adult cardiac surgery: current options and future challenges.
Current techniques of myocardial protection are evolving with the use of less conventional modalities of cardioplegia and have reduced the morbidity and mortality of cardiac operations. Blood cardioplegic solutions appear superior to cold cardioplegia in terms of myocardial protection and adjuncts as glutamate/aspartate enhancement, antioxidant supplementation, nitric oxide donors and maintenance of calcium homeostasis seem effective. In the near future, further experimental and clinical investigations about pharmacological preconditioning, sodium-hydrogen exchangers inhibition and gene therapy need to be addressed to well define their potential role in the improvement of current techniques of myocardial protection that are suboptimal in high-risk clinical settings.
Nicolini
Francesco
F
Department of Cardiac Surgery, University of Parma, Parma, Italy. francesconicolini@libero.it
Beghi
Cesare
C
Muscari
Claudio
C
Agostinelli
Andrea
A
Maria Budillon
Alessandro
A
Spaggiari
Igino
I
Gherli
Tiziano
T
D006348:Cardiac Surgical Procedures / Q000379:methods*; D006324:Heart Arrest, Induced / Q000379:methods* / Q000639:trends; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control