Reducing postischemic damage by temporary modification of reperfusate calcium, potassium, pH, and osmolarity

Integrated Myocardial Management: Background and Initial Application

“…(4) Simultaneous antegradehetrograde perfusion is safe and may facilitate both myocardial protection and the technical ease of the operation. (5) The continuity of the operation is not to be interrupted to deliver perfusion (blood or cardioplegia) while the aorta is clamped. The only exception is during induction when aortic regurgitation may be produced by distorting the aortic valve when manipulating the heart.…”

“…This approach coordinates the myocardial protective techniques with the continuity of the operation so that the surgical procedure is never interrupted. This method (1) provides unimpaired vision, (2) avoids unnecessary ischemia and cardioplegic overdose, (3)allows aortic clamping as soon as cardiopulmonary bypass is started, (4) permits aortic unclamping and discontinuation of bypass shortly after the technical procedure is completed, (5) minimizes the duration of ischemia and cardiopulmonary bypass, and (6) maximizes the positive attributes of the strategies available currently. The background for this myocardial management method, which combines antegradelretrograde delivery, warm/cold blood cardioplegia, intermittent/continuous perfusion, blood/blood cardioplegia, and avoidance of cardioplegic overdose, hemodilution, and tangential aortic clamping, is discussed.…”

“…The overriding principle is the marriage of cardioprotective strategies to conduct of the operation so that the surgeon can work without interrupting the continuity of the operation. This procedure (1) provides unimpaired vision, (2) avoids unnecessary ischemia and cardioplegic overdose, (3) allows aortic clamping as soon as cardiopulmonary bypass is begun, (4) permits aortic unclamping and discontinuation of bypass shortly after the technical aspects of the operation are completed, (5) minimizes the duration of ischemia and cardiopulmonary bypass, and (6) maximizes the positive attributes of the strategies available currently.…”

Use of (All-Blood) Miniplegia Versus Crystalloid Cardioplegia in an Experimental Model of Acute Myocardial Ischemia

“…In the late 1970s and early 1980s, laboratory studies suggested that blood was the best vehicle to deliver a cardioplegic solution, especially to the ischemic myocardium. 1 The use of blood as a vehicle is based on its superior oxygen transportation capabilities, osmotic and buffer properties, and endogenous and antioxidant nutrients, when compared to crystalloid solutions.…”

“…In the late 1970s, studies suggested that blood is the best vehicle for cardioplegia. 1 The use of blood is based on its superior oxygen carrying capabilities, better osmotic properties, and superior antioxidant capacity if compared to crystalloid solutions. The original formulation for all-blood cardioplegia was diluted to 25% in order to avoid formation of microaggregates and blood cell pile up.…”