Myocardial preservation during cardiopulmonary bypass
Cardiopulmonary Bypass: Advances in Extracorporeal Life Support, Elsevier, ss.311-326, 2022
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2022
- Doi Numarası: 10.1016/b978-0-443-18918-0.00019-x
- Yayınevi: Elsevier
- Sayfa Sayıları: ss.311-326
- Anahtar Kelimeler: Aortic cross-clamp, blood cardioplegia, cardiac arrest, cardioplegia, cardiopulmonary bypass, crystalloid, ischemia–reperfusion injury, myocardial protection, open-heart surgery
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
The goal of the open-heart surgery technique during cardiac, aortic, or thoracic procedures is to protect the myocardium both functionally and structurally. In open-heart surgery, myocardial damage caused by the ischemia–reperfusion injury cascade is still one of the most challenging complications; however, how should it be avoided, prevented, and protected as much as possible, such as by supplying adequate blood flow intermittently or continuously, needs to be answered. The balance between myocardial oxygen consumption and supply must also be maintained; disturbance of this balance may negatively adversely affect energetics, morphology, and functions at the cellular level. Various approaches can be employed for myocardial protection to maintain this balance positively at the supply side during surgery, which include on-pump with cardioplegic arrest, on-pump with deep hypothermic circulatory arrest, or on-pump beating heart without aortic cross-clamp (ACC). A consensus about myocardial protection is still not established; however, myocardial protection with cardioplegia is a universally accepted approach to preserving myocardial contractile elements and energy stores while providing a quiet and bloodless surgical field. Myocardial reperfusion injury after ACC removal results in myocyte damage through mechanisms different from those that occur during acute myocardial infarction, such as those primarily caused by myocardial ischemia as a procedural imperative and secondary due to myocardial cardioplegic arrest. In this chapter, myocardial protection during the application of open-heart surgery techniques and the efficacy of cardioplegia are explained in detail and each aspect is elucidated.