Cardioplegia and cardiac surgery: Pharmacological arrest and cardioprotection during global ischemia and reperfusion

Chambers, David J.; Fallouh, Hazem B.

doi:10.1016/j.pharmthera.2010.04.001

Cited by 124 publications

(84 citation statements)

References 125 publications

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“…For example, the majority of cardiac surgeries are performed on an ischemic, nonbeating heart achieved by cross-clamping the aorta (thus interrupting coronary artery perfusion), with systemic blood circulation achieved via extracorporeal circulation (ECC). In addition to IRI to the heart, ECC itself causes a systemic inflammatory response leading to activation of circulating leukocytes and a prothrombic state potentially contributing to cardiac dysfunction [13, 14]. …”

Section: The Surgical Stress Response and Associated Complicationsmentioning

confidence: 99%

Is Overnight Fasting before Surgery Too Much or Not Enough? How Basic Aging Research Can Guide Preoperative Nutritional Recommendations to Improve Surgical Outcomes: A Mini-Review

Longchamp

Harputlugil²,

Corpataux³

et al. 2017

Gerontology

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Dietary restriction (DR) is best known for extending lifespan in experimental model organisms, but also increases resistance to a variety of clinically relevant stressors, including those associated with surgery. Extended periods of DR, lasting months to years, are required for optimal longevity benefits in rodents, but short-term dietary preconditioning (less than 1 week) remarkably protects from acute injury. Here, we discuss recent advances in our understanding of the mechanistic basis of short-term DR and fasting in the context of surgical stress resistance, including upstream amino acid sensing by the GCN2 and mTORC1 pathways, and downstream effector mechanisms including increased insulin-dependent prosurvival signaling and elevated endogenous hydrogen sulfide production. We also review the current trend in preoperative nutrition away from preoperative fasting and towards carbohydrate loading. Finally, we discuss the rationale for the nonmutually exclusive use of brief DR or pharmacological DR mimetics to precondition against the stress and potential complications of surgery.

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Section: The Surgical Stress Response and Associated Complicationsmentioning

confidence: 99%

Is Overnight Fasting before Surgery Too Much or Not Enough? How Basic Aging Research Can Guide Preoperative Nutritional Recommendations to Improve Surgical Outcomes: A Mini-Review

Longchamp

Harputlugil²,

Corpataux³

et al. 2017

Gerontology

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“…This leads to the reduction in the calcium influx into myocytes (by reducing the action potential) without having to add other agents with adverse effects. Studies with aprikalim, pinacidil, or nicorandil showed a comparable or better cardioprotection level but failed in clinical practice due to a long elimination time and systemic hypotension [13]. …”

Section: Cardioplegiamentioning

confidence: 99%

Adjuvant Cardioprotection in Cardiac Surgery: Update

Wágner

Piler

Gabbasov

et al. 2014

BioMed Research International

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Cardiac surgery patients are now more risky in terms of age, comorbidities, and the need for complex procedures. It brings about reperfusion injury, which leads to dysfunction and/or loss of part of the myocardium. These groups of patients have a higher incidence of postoperative complications and mortality. One way of augmenting intraoperative myocardial protection is the phenomenon of myocardial conditioning, elicited with brief nonlethal episodes of ischaemia-reperfusion. In addition, drugs are being tested that mimic ischaemic conditioning. Such cardioprotective techniques are mainly focused on reperfusion injury, a complex response of the organism to the restoration of coronary blood flow in ischaemic tissue, which can lead to cell death. Extensive research over the last three decades has revealed the basic mechanisms of reperfusion injury and myocardial conditioning, suggesting its therapeutic potential. But despite the enormous efforts that have been expended in preclinical studies, almost all cardioprotective therapies have failed in the third phase of clinical trials. One reason is that evolutionary young cellular mechanisms of protection against oxygen handling are not very robust. Ischaemic conditioning, which is among these, is also limited by this. At present, the prevailing belief is that such options of treatment exist, but their full employment will not occur until subquestions and methodological issues with the transfer into clinical practice have been resolved.

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“…Until the present day, cardioplegic arrest remains the gold standard of cardioprotection and requires a potassium rich solution sending the heart into a depolarized arrest [1]. Despite its almost universal usage, cardioplegia in its current form is associated with potential downsides rendering those cardioprotective regimens a less than optimal choice in certain clinical situations and certain patient collectives.…”

Section: Introductionmentioning

confidence: 99%

“…Factors influencing operative risk include age >70, female sex, renal impairment, extracardiac arteriopathy, chronic lung disease, pulmonary hypertension, insulin dependent diabetes, NYHA III/IV, and ejection fraction <50%. This is especially important in the present light of change in the field of interventional cardiology offering catheter-guided approaches to an increasingly larger patient cohort causing a shift in cardiac surgery away from isolated “simple” procedure towards more complex interventions [4], sometimes in the very old and the severely ill [1, 3]. This increase in case complexity in a changing patient population is especially relevant for patients with impaired ventricles associated with left ventricular hypertrophy (LVH) and heart failure where it is generally acknowledged that current methods of myocardial protection are inadequate.…”

Section: Introductionmentioning

confidence: 99%

Cardioprotection: A Review of Current Practice in Global Ischemia and Future Translational Perspective

Habertheuer

Kocher

Laufer

et al. 2014

BioMed Research International

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The idea of protecting the heart from ischemic insult during heart surgery to allow elective cardiac arrest is as old as the idea of cardiac surgery itself. The current gold standard in clinical routine is a high potassium regimen added either to crystalloid or blood cardioplegic solutions inducing depolarized arrest. Ongoing patient demographic changes with increasingly older, comorbidly ill patients and increasing case complexity with increasingly structurally abnormal hearts as morphological correlate paired with evolutions in pediatric cardiac surgery allowing more complex procedures than ever before redefine requirements for cardioprotection. Many, in part adversarial, regimens to protect the myocardium from ischemic insults have entered clinical routine; however, functional recovery of the heart is still often impaired due to perfusion injury. Myocardial reperfusion damage is a key determinant of postoperative organ functional recovery, morbidity, and mortality in adult and pediatric patients. There is a discrepancy between what current protective strategies are capable of and what they are expected to do in a rapidly changing cardiac surgery community. An increased understanding of the molecular players of ischemia reperfusion injury offers potential seeds for new cardioprotective regimens and may further displace boundaries of what is technically feasible.

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Cardioplegia and cardiac surgery: Pharmacological arrest and cardioprotection during global ischemia and reperfusion

Cited by 124 publications

References 125 publications

Is Overnight Fasting before Surgery Too Much or Not Enough? How Basic Aging Research Can Guide Preoperative Nutritional Recommendations to Improve Surgical Outcomes: A Mini-Review

Is Overnight Fasting before Surgery Too Much or Not Enough? How Basic Aging Research Can Guide Preoperative Nutritional Recommendations to Improve Surgical Outcomes: A Mini-Review

Adjuvant Cardioprotection in Cardiac Surgery: Update

Cardioprotection: A Review of Current Practice in Global Ischemia and Future Translational Perspective

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