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J Thorac Cardiovasc Surg 2002;124:219-220
© 2002 The American Association for Thoracic Surgery

Editorials

Oxygenated multidose delivery of crystalloid esmolol cardioplegia as an alternative to high potassium cardioplegia

James D. McCully, MD

From the Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Institutes of Medicine, Boston, Mass.

Received for publication Oct 22, 2001. Accepted for publication Oct 31, 2001. Address for reprints: James D. McCully, MD, the Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Institutes of Medicine, 77 Avenue Louis Pasteur, Room 144, Boston, MA 02115.

The first 20% of the full text of this article appears below.


   Introduction
 
See related article on page 340.

Cardioplegia is used as a myoprotective agent for the alleviation of surgically induced ischemic injury, incurred during cardiac operative procedures, to allow the functional preservation of the myocardium. These solutions allow for the rapid electromechanical arrest of the myocardium through alteration of cellular electrochemical gradients.Go 1 Most cardioplegic solutions use a high potassium content to arrest the heart.Go 2 The use of hypothermic potassium cardioplegia in adult cardiac surgery increases the safely available intraoperative time and has been correlated with improved postischemic myocardial functional recovery and reduced postoperative mortality.Go 3

Potassium-induced arrest maintains the heart in a depolarized state, significantly decreasing the energy demand of the myocardium, but basal metabolic energy requirements are sustained and thus still constitute a significant energy expenditure.Go 4 The advantages of cardioplegic arrest in providing a bloodless field are tempered by the fact that depolarization also leads to the alteration of ion flux across the sarcolemmal membrane and is associated with both increased cytosolic calcium accumulation and . . . [Full Text of this Article]






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