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Myocardial Protection During Cardiac Surgery

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Book cover Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery

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Abstract

Adequate myocardial protection is an integral part of the safe conduct of cardiac surgery. The mainstay of myocardial protection is cardioplegia. Since the concept of reversible chemically-induced cardiac arrest was first introduced in the 1950s, a number of different cardioplegic solutions have been developed. As a result, there is wide variability in clinical practice and, despite the publication of numerous comparative clinical studies, there is no clear consensus regarding the optimal strategy for myocardial protection in adult cardiac surgery. In this chapter, we briefly survey the history of myocardial protection. We describe the main types of cardioplegic solutions currently available, and discuss controversies surrounding optimal temperature and method of delivery, highlighting the advantages and limitations of various approaches. Finally, we briefly discuss the emerging evidence regarding novel strategies for myocardial protection using single-dose solutions.

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Author information

Authors and Affiliations

  1. Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Amine Mazine & Myunghyun M. Lee

  2. Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Terrence M. Yau

  3. Peter Munk Cardiac Centre, Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada

    Terrence M. Yau

Authors
  1. Amine Mazine
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  2. Myunghyun M. Lee
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  3. Terrence M. Yau
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Corresponding author

Correspondence to Terrence M. Yau .

Editor information

Editors and Affiliations

  1. Distinguished University Professor Department of Anesthesia and Perioperative Medicine and Department of MedicineDivision of Critical Care Medicine, London Health Sciences Center and St Joseph’s Healthcare London Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI) Western University, London, ON, Canada

    Davy C.H. Cheng

  2. Associate Professor Department of Anesthesia and Perioperative Medicine and Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Centre for Medical Evidence, Decision Integrity and Clinical Impact (MEDICI) Western University, London, ON, Canada

    Janet Martin

  3. Professor of Surgery University of Toronto, Melanie Munk Chair of Cardiovascular Surgery University Health Network, Toronto, ON, Canada

    Tirone David

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Mazine, A., Lee, M.M., Yau, T.M. (2021). Myocardial Protection During Cardiac Surgery. In: Cheng, D.C., Martin, J., David, T. (eds) Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-47887-2_34

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  • DOI: https://doi.org/10.1007/978-3-030-47887-2_34

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-47886-5

  • Online ISBN: 978-3-030-47887-2

  • eBook Packages: MedicineMedicine (R0)

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