RT Book, Section
A1 Mentzer, Jr., Robert M.
A1 Gottlieb, Roberta A.
A1 Przyklenk, Karin
A1 Jahania, M. Salik
A2 Cohn, Lawrence H.
SR Print(0)
ID 55915028
T1 Chapter 15. Myocardial Protection
T2 Cardiac Surgery in the Adult, 4e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-163310-9
LK accesscardiology.mhmedical.com/content.aspx?aid=55915028
RD 2024/04/24
AB In  the  setting  of  heart  surgery,  myocardial  protection  refers  to  strategies  and  methodologies  used  in  the  operating  room  to  attenuate  or  prevent  perioperative  infarction  and/or  postischemic  ventricular  dysfunction.  This  is  in  contrast  to  the  instance  in  which  a  patient  presents  with  an  acute  myocardial  infarction  (MI).  Here  the  objective  is  to  reduce  infarct  size  at  reperfusion.  The  underlying  pathophysiology  in  both  settings,  however,  relates  to  the  etiology  and  consequences  of  ischemia-reperfusion  injury.  After  surgery  the  injury  manifests  by  low  cardiac  output,  hypotension,  and  a  need  for  postoperative  inotropic  support.  The  damage  may  be  reversible  or  irreversible  and  is  differentiated  by  the  presence  of  electrocardiographic  abnormalities,  elevations  in  the  levels  of  specific  plasma  enzymes  or  proteins  such  as  creatine  kinase  and  troponin  I  or  T,  and/or  the  presence  of  regional  or  global  echocardiographic  wall  motion  abnormalities.  Depending  on  the  criteria,  the  incidence  of  postoperative  MI  after  CABG  surgery  ranges  between  3%  and  18%.  The  incidence  of  severe  ventricular  dysfunction,  heart  failure,  and  death,  despite  advances  in  surgical  techniques,  ranges  between  2  and  15%;  the  higher  mortality  rates  are  associated  with  high-risk  patients  with  minimal  cardiac  reserve.