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Intraoperative myocardial protection
Book chapter

Intraoperative myocardial protection

John W. Entwistle and Andrew S. Wechsler
Techniques in Extracorporeal Circulation 4E, pp 202-227
2004
DOI: https://doi.org/10.1201/b13407-20

Abstract

The goal of any cardiac procedure is to improve or preserve cardiac performance. Paramount to this goal, the cardiac surgeon must avoid unnecessarily imposing further injury upon the heart. This requires a comprehensive myocardial protection policy that encompasses the conduct of the operation before, during and after the period of ischaemia. Failure to protect the heart adequately at any stage may negate the efforts at other times in the procedure and result in myocardial injury and permanent dysfunction. As the patient population has grown progressively older, preoperative myocardial function that once precluded operation is now commonplace and myocardial protective strategies have become increasingly complex. In addition, any cardiac operation may present challenges that require modification of a surgeon’s usual protective strategy. Thus, a thorough understanding is required of the available techniques, and the rationale behind them, in order to provide any given individual with the most appropriate myocardial protection for the situation. Although the potential methods for myocardial protection are numerous, only a few strategies are in common use. There are many variations in the details even between similar protocols, but only the most common variables are discussed here.

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