Evolution of Myocardial Protection | Chapter 1 | Highlights on Medicine and Medical Science Vol. 7

 The majority of cardiac surgery patients are operated on utilising the cardioprotective approach known as ischemic cardioplegic arrest in order to keep the operative field calm and bloodless. Myocardial protection is currently based on hyperkalaemic arrest, which is supplemented by hypothermia, a variety of additives, and combining the cardioplegic solution with the patient's blood. In terms of age, comorbidities, and the necessity for complicated treatments, cardiac surgery patients are becoming more dangerous. Patients in these groups have a higher risk of post-procedural complications and mortality. The existing limits of intraoperative cardioplegia are one thing to consider. It causes reperfusion damage, which results in myocardial dysfunction and/or loss of a portion of the myocardium.

Acute myocardial infarction patients treated with modern mechanical revascularization principles develop post-infarct heart failure, which is now on the rise in cardiology.

As a result, any reduction in periprocedural myocardial damage is obviously crucial for the patient's prognosis. Ischemic conditioning, which is evoked by brief non-lethal episodes of ischaemia-reperfusion, is one strategy to improve myocardial protection. In addition, medications that imitate ischemic conditioning are being tried (and generating a lot of attention). Reperfusion damage, a complicated reaction of the organism to the restoration of coronary blood flow in ischemic tissue, can finally lead to cell death, is the target of such cardioprotective treatments. The basic processes of reperfusion damage and myocardial conditioning have been elucidated via extensive research over the last three decades, indicating therapeutic promise. However, despite massive efforts and money spent in preclinical investigations, practically all cardioprotective medicines failed in the third phase of clinical trials. One reason is because the cellular mechanisms of defence against oxygen handling in evolutionary young cells are not very robust. This also limits ischaemic conditioning, which is one of them. The current consensus is that such therapeutic options exist, but that full implementation will not occur until subquestions and methodological concerns with the transfer into clinical practise are overcome.

Author (S) Details

Robert Wagner
Department of Cardiovascular Anesthesiology and Intensive Postoperative Care, Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic.

Petr Fila
Department of Cardiovascular Surgery and Transplantation, Faculty of Medicine, Masaryk University, Brno, Czech Republic and Department of Cardiac Surgery, Centre of Cardiovascular Surgery and Transplantation Brno, Brno, Czech Republic.

Zufar Gabbasov
Institute of Experimental Cardiology, Russian Cardiology and Research Complex, Moscow, Russia.

Junko Maruyama
Department of Anesthesiology and Critical Care Medicine, Mie University School of Medicine and Department of Clinical Engineering, Suzuka University of Medical Science, Mie, Japan.

Kazuo Maruyama
Department of Anesthesiology and Critical Care Medicine, Mie University School of Medicine and Department of Clinical Engineering, Suzuka University of Medical Science, Mie, Japan.

Jiri Nicovsky
Department of Cardiovascular Surgery and Transplantation, Faculty of Medicine, Masaryk University, Brno, Czech Republic and Department of Cardiac Surgery, Centre of Cardiovascular Surgery and Transplantation Brno, Brno, Czech Republic.

Petr Nemec
Department of Cardiovascular Surgery and Transplantation, Faculty of Medicine, Masaryk University, Brno, Czech Republic and Department of Cardiac Surgery, Centre of Cardiovascular Surgery and Transplantation Brno, Brno, Czech Republic.

View Book :- https://stm.bookpi.org/HMMS-V7/article/view/2029