Much More Than Enriched Myocardial Fuel
نویسنده
چکیده
As in many other medical specialties, cardiac surgery is exploring its boundaries. The patient population scheduled for cardiac surgery is aging, and the surgical procedures are becoming more complex, leading to significant comorbidity. In addition, the myocardium is often poorly functioning; cardiac remodeling resulting from myocardial ischemic events or longstanding volume and/or pressure overload often results in low ejection fractions and increases the risk of low cardiac output in the early postoperative period of cardiac surgery. One example is aortic valve replacement for critical aortic stenosis with significant left ventricular hypertrophy. Many techniques aiming to optimize myocardial protection are used with variable success. Composition, temperature, and delivery route of cardioplegia are still matters of debate among cardiac surgeons; pharmacological interventions and the use of biocompatible materials to modulate the inflammatory response, evoked by surgery and cardiopulmonary bypass, are part of ongoing research projects. Interventions aiming to reduce the ischemia/reperfusion injury face difficulty translating their promising results from experimental settings into daily clinical practice; thus, the search for simple, inexpensive techniques to improve myocardial protection and outcome continues.
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