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Current Approaches to Prevention and Management of Reperfusion Injury

  • Wichert J. Kuijt
  • Judson Williams
  • Christopher B. Granger
  • Mitchell W. Krucoff
  • Matthew T. RoeEmail author
Chapter

Abstract

As our understanding of the pathophysiological underpinnings of reperfusion injury has increased, many therapies directed at preventing the detrimental effects of this phenomenon have been tested. For primary PCI, this has ranged from mechanical protection from distal embolization of plaque material, preventing calcium overload after reperfusion, to the inhibition of specific inflammatory mediators. Although most have shown promise in smaller mechanistic clinical trials, only mechanical thrombectomy has thus far been shown to be of clinical benefit in larger investigations.

Additionally, the occurrence of ventricular arrhythmias poses a threat not only due to (1) electrical failure and subsequent asystole but also because (2) bursts of ventricular activity around the time of reperfusion signify a larger infarct size and subsequent long-term risk of pump failure. Prophylactic treatment with antiarrhythmic drugs has thus far been shown to increase mortality, and investigations are ongoing to improve our understanding of these arrhythmias and to identify patients at high risk that may benefit from treatment.

For the prevention of reperfusion injury in coronary artery bypass grafting, the optimum combination of cardioplegic solutions and temperature has not yet been determined. No regimen has been shown to confer superior myocardial salvage over another, with cold blood crystalloid infusion having become the most used worldwide. As in primary PCI, the search continuous for specific cardioprotective compounds and identifying patients at high risk to optimize treatment strategies.

Keywords

Prevention and management Embolic events Thrombectomy Aspiration catheter Reperfusion arrhythmias Pharmacological management Cardiac surgery Myocardial reperfusion injury Microvascular obstruction Coronary microembolization 

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Copyright information

© Springer-Verlag London 2012

Authors and Affiliations

  • Wichert J. Kuijt
    • 1
  • Judson Williams
    • 2
  • Christopher B. Granger
    • 3
  • Mitchell W. Krucoff
    • 4
  • Matthew T. Roe
    • 5
    Email author
  1. 1.Department of CardiologyAcademic Medical Center – University of AmsterdamAmsterdamThe Netherlands
  2. 2.Department of Surgery, Division of Cardiac SurgeryDuke UniversityDurhamUSA
  3. 3.Department of Cardiology, Division of Cardiovascular MedicineDuke University Medical Center, Duke Clinical Research InstituteDurhamUSA
  4. 4.Department of Medicine, Division of CardiologyDuke University Medical CenterDurhamUSA
  5. 5.Division of Cardiovascular MedicineDuke University Medical Center, Duke Clinical Research InstituteDurhamUSA

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