Cardioprotective Strategies in Cardiac Surgery

• The heart under consideration may present a complex picture of preoperative disease, variable age, gender, metabolic and cellular dysfunction, global or regional ischemia (both acute and chronic), each of which contribute to differing vulnerabilities to ischemia and reperfusion injuries.
• However, adequate myocardial protection must be based on a sound scientific basis.
• Obviously, a single cardioprotective strategy may be inadequate to suit all surgeon preferences and target all patient pathologies. Hence, the surgical team must often mold the composition of the cardioplegic solution or its modality of delivery to meet the requirements of the patient’s pathologic profile as presented.
• The measures taken to protect the heart during elective cardiac arrest should represent a balance struck between the requirements of the heart during aortic cross-clamp or reperfusion, with appropriate adjustments made for special considerations (hypertrophy, diffuse coronary disease), and avoid distraction from the surgical procedure. Ischemia and reperfusion injury and the choice of cardioplegia technique represent primary contributors to patient outcomes.

Explore the complexities of myocardial protection in cardiac surgery, including considerations for preoperative disease, age, gender, and metabolic dysfunction. Understand the need for tailored cardioprotective strategies based on the patient’s pathologic profile and the balance required between the heart's requirements and the surgical procedure.