Myocardial Protection

Abstract

Optimizing clinical outcomes in cardiac surgery depends upon the performance of a technically proficient operation without incurring myocardial damage during the procedure. Adherence to this principle is imperative, whether a minimally invasive, robotic, off-pump, or conventional surgical approach through a median sternotomy is performed. This chapter discusses the techniques to minimize myocardial injury during cardiac surgical procedures, principles of cardioplegia, and the cardioplegia strategy. Excellent myocardial protection is essential to optimize the short- and long-term results of surgery. In some situations, modifications of traditional approaches to myocardial protection with cardioplegia may prove beneficial. In circulatory arrest cases for aortic root and arch surgery, cardioplegia should be either administered directly into the coronary ostia or given retrograde just prior to or at the time that circulatory arrest is initiated.