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Blood cardioplegic strategies during adult cardiac operations

  • Chapter
Ischemia-reperfusion in cardiac surgery

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 142))

Abstract

Pharmacologic cardioplegia was not used widely in the United States until the past fifteen years because of previous reports of left ventricular damage following cold hypertonic potassium citrate blood as introduced by Melrose et al. in 1955 [1, 2]. Studies by Bretschneider [3], Kirsch [4], and Hearse [5] and their co-workers in Europe and by Gay and Ebert [6] provide a solid framework for the renewed interest in cardioplegia which has resulted in the intraoperative use of pharmacologic cardioplegia by most surgeons throughout the world. Tyers et al. [7] showed that the problem with Melrose solution was inappropriate concentration of its constituents, rather than an inappropriate composition. Our studies fully support the original cardioplegic constituents of Melrose solution and we now use safe concentrations of alkaline, hypertonic, potassium citrate, and cold blood to stop the heart whenever we clamp the aorta during clinical surgery [8], the safety of this approach has been confirmed by others [9–12]. Cold cardioplegic solutions are used almost universally to prevent intraoperative myocardial ischemic damage during aortic clamping. This review shows that the inclusion of oxygen in the cardioplegic solution expands the therapeutic scope for clinical cardioplegia. It describes how these same solutions can be delivered warm to allow their use for active resuscitation before ischemia is imposed, and how to avoid and reverse ischemic and reperfusion damage before and after aortic unclamping. It reiterates briefly the principles that must underlie the composition of cardioplegic solutions and puts into perspective the commonality of apparently different pharmacologic approaches to myocardial protection [13]. It focuses primarily on the principles that form the basis for clinical strategies for cardioplegic delivery that can ensure that the selected cardioplegic solution can exert its desired effect and it describes how these can be implemented. Each proposed strategy can be used with oxygenated cardioplegic solutions (regardless of precise composition) and several are applicable to asanguineous cardioplegic solutions devoid of oxygen.

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Authors
  1. Gerald D. Buckberg
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  2. Bradley S. Allen
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  3. Friedhelm Beyersdorf
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Editor information

Editors and Affiliations

  1. Institute of Physiology, Heinrich-Heine-University, Düsseldorf, Germany

    Hans Michael Piper

  2. Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University, Düsseldorf, Germany

    Claus J. Preusse

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© 1993 Springer Science+Business Media Dordrecht

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Buckberg, G.D., Allen, B.S., Beyersdorf, F. (1993). Blood cardioplegic strategies during adult cardiac operations. In: Piper, H.M., Preusse, C.J. (eds) Ischemia-reperfusion in cardiac surgery. Developments in Cardiovascular Medicine, vol 142. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-1713-5_7

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  • DOI: https://doi.org/10.1007/978-94-011-1713-5_7

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-4750-0

  • Online ISBN: 978-94-011-1713-5

  • eBook Packages: Springer Book Archive

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