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Standardization of myocardial protection: comment on "Cardiac surgery 2023 reviewed".
Thorac Cardiovasc Surg
December 2024
Cardiovascular Departement, University Hospital Bern, Bern, Switzerland.
There have been few recent innovations since the introduction of cardioplegia more than 50 years ago. Surprisingly, cardioplegia as one of the most essential steps in terms of heart muscle protection during a surgical procedure requiring cardiac arrest has never been really standardized. As a consequence, a considerable variety of cardioplegic solutions and applications have developed: cold versus warm, crystalloid versus blood cardioplegia, antegrade versus retrograde or both, as well as different time schedules for repeated administration.
View Article and Find Full Text PDFCompact Arterial Monitoring Device Use in Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): A Simple Validation Study in Swine.
Cureus
October 2024
Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, USA.
Article Synopsis
- - Hemorrhage is the main cause of preventable death in trauma situations, leading to military and civilian advancements in medical practices, particularly through the use of tourniquets to manage extremity bleeding and save lives.
- - While tourniquets have significantly decreased deaths from bleeding in military settings, noncompressible hemorrhage still poses a major risk, especially before patients receive definitive medical care.
- - The study explores using a small, disposable pressure monitor during resuscitative endovascular balloon occlusion of the aorta (REBOA) to enhance blood pressure monitoring, facilitate better resuscitation practices, and reduce the need for blood products in extreme environments.
Introduction: del Nido cardioplegia was developed for immature myocardium to prevent myocardial damage by Ca in traditional blood cardioplegia. But due to increased hemodilution and decreased colloid oncotic pressure it may cause myocardial edema and increased cardiac morbidity. Microplegia may have better cardioprotection in comparison to del Nido as there is less hemodilution.
View Article and Find Full Text PDFReduced Invasiveness of Cardiopulmonary Bypass: The Mini-Circuit and the Micro-Cardioplegia.
J Cardiovasc Dev Dis
July 2023
Departement of Cardiac Surgery, University of Zürich, CH-8006 Zürich, Switzerland.
The aim of cardiopulmonary bypass is the maintenance of a sufficient whole body perfusion and gas exchange during open or closed heart surgery procedure (coronary artery bypass grafting, valve repair and replacement, surgical intervention on the ascending aorta and/or aortic arch, repair of congenital malformations, and finally implantation of ventricular assist devices or cardiac transplantation). The main components of cardiopulmonary bypass are the pump that supplies the circulation and the oxygenator that regulates gas exchange. However, even though this technology has been extensively developed and improved over the last decades, one of the major drawbacks-which is the fact that blood has to flow through tubing systems with foreign surfaces-persists so far.
View Article and Find Full Text PDFMicroplegia in paediatric hearts.
Perfusion
November 2023
Department of Paediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany.
Introduction: A basic prerequisite for a good surgical outcome in heart surgery is optimal myocardial protection. However, cardioplegia strategies used in adult cardiac surgery are not directly transferable to infant hearts. Paediatric microplegia, analogous to Calafiore cardioplegia used in adult cardiac surgery, offers the advantage of safe myocardial protection without haemodilution.
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