Coronary Flow Response After Myocardial Ischemia May Predict Level of Functional Recovery

Abstract

After its widespread introduction in the 1970s, cold crystalloid cardioplegia rapidly became standard practice in cardiac surgery. A changing patient population, with more elderly patients, patients requiring reoperation, and undergoing more complex procedures, s creating a demand for more sophisticated cardioprotective protocols. Continuous blood cardioplegia has been used, conferring the advantages of blood perfusion, including greater oxygen-carrying and buffering capacity, and avoiding ischemia and thus reperfusion injury, but creating the problem of an obscured operating field. The most recent proposal, intermittent warm blood cardioplegia, offers a still, clear operating field, with ischemic intervals short enough to prevent serious damage. Buckberg et al (1995) review the history of cardioprotection, detail the various options now available, and plead for the introduction of integrated myocardial management, in which the surgeon adapts the cardioprotective strategy to the needs of each patient, rather than adopting an adversarial position. Buckberg (1994) also observes that new cardioprotective techniques are being introduced without an adequate scientific basis.