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Overview: procedure versus protection: an impossible separation.

Abstract

This overview focuses upon the fundamental cohesion between myocardial protection and mechanical repair for surgical success. Currently, our attention is directed toward the natural evolution of more complex surgical methods, while there is slower rise in interest in advanced methods of protection. The absence of manuscripts on myocardial protection in major meetings suggests that the concept of protection has been solved, even though there remain reports of use of intraaortic balloon and mechanical devices that appear when protection is inadequate. This Seminar volume will introduce a series of articles about risk patients for whom evolving methods of protection are used. We will point out frontiers of protection that should develop together with advances in technical surgical approaches so that these two essential components that insure the safe conduct of cardiac operations can grow together.

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BibTeXRIS

G D Buckberg. 2001. Overview: procedure versus protection: an impossible separation.. https://doi.org/10.1053/stcs.2001.22733

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Myocardial protection during surgical ventricular restoration.

OBJECTIVE: Ventricular restoration is a novel procedure for treating congestive heart failure (CHF). The two important features include a technically correct procedure and adequate myocardial protection. The two protective techniques include conventional cardioplegia and the beating heart. METHODS: This report reviews a RESTORE clinical registry and summarizes background experimental work related to myocardial protection in failing dilated hearts. RESULTS: The RESTORE registry is reported, where protection is 55% with cardioplegia and 45% with beating heart. The beating method was used more frequently in patients with ejection fraction <30%, end systolic volume 80 ml/m2, NYHA class >III/IV. Overall survival results favored cardioplegia except for the first 30 days, but after matching patients on age, ejection fraction (EF) and NYHA the beating results and cardioplegic results were comparable. Experimental work evaluated the safety of the beating method in failing dilated ventricles under acute conditions. Supplemental coronary perfusion studies in chronically dilated hearts after tachycardia induced cardiomyopathy were analyzed to show that (a) there was vascular remodeling (less flow at the same pressure in failing hearts with cardioplegic, but not beating delivery; (b) in the open state (used during restoration) subendocardial flow increased in the beating heart, and fell after cardioplegia. These studies were done without ischemia. CONCLUSIONS: Cardioplegic delivery for protection is 'time dependent' (needing ischemic intervals) while beating nourishment is 'procedure dependent,' as continuous perfusion is provided throughout the procedure is suggested. The importance of maintaining high perfusion pressure is emphasized.

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