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Cardioplegia and cardiac function

  • Chapter
Ischemia-reperfusion in cardiac surgery

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 142))

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Abstract

Preservation of myocardial integrity and function during cardioplegic arrest has improved steadily in recent years with the widespread use of selective cardiac hypothermia and potassium containing cardioplegia [1–7]. Most operations involving open-heart surgery can now be completed with a cardioplegic arrest of less than 120 minutes duration. Nevertheless, in a number of patients the heart recovering from the surgical trauma and the cardioplegic arrest cannot provide a sufficient peripheral circulation in the immediate postoperative period, although coronary blood flow is restored, and there is no myocardial necrosis. This reversible impairment of postoperative ventricular function represents a form of global myocardial ‘stunning’ [8]. With the restoration of coronary blood flow, there is a rapid recovery of metabolic parameters. Creatine phosphate is repleted [9,10], lactate production is reversed to consumption [11], and tissue pH is normalized [9]. Changes in myocardial water content occur only to a minor extent during cardioplegia and tissue edema resolves quickly upon reperfusion [12]. Changes of the ST-segment and cardiac rhythm [13–15] are normalized within minutes after reperfusion. Thus, reversibly depressed ventricular function following cardioplegic arrest has no metabolic, electrophysiological or structural correlate and must therefore be assessed as a separate entity. The adequate assessment of cardiac function and its management during the critical postoperative period is essential to the outcome of the operative procedure and the prognosis of patients undergoing cardiac surgery [16,17].

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Authors
  1. Dietrich Baumgart
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  2. Rainer Schulz
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  3. Thomas Ehring
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  4. Gerd Heusch
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Editor information

Editors and Affiliations

  1. Institute of Physiology, Heinrich-Heine-University, Düsseldorf, Germany

    Hans Michael Piper

  2. Department of Thoracic and Cardiovascular Surgery, Heinrich-Heine-University, Düsseldorf, Germany

    Claus J. Preusse

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© 1993 Springer Science+Business Media Dordrecht

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Baumgart, D., Schulz, R., Ehring, T., Heusch, G. (1993). Cardioplegia and cardiac function. In: Piper, H.M., Preusse, C.J. (eds) Ischemia-reperfusion in cardiac surgery. Developments in Cardiovascular Medicine, vol 142. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-1713-5_19

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  • DOI: https://doi.org/10.1007/978-94-011-1713-5_19

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