Abigail Whittaker1,
Maryam Aboughdir1,2, Samiha Mahbub1,
Amer Harky3,4
Department of Medicine, St George’s University of London, London, UK.
Department of Medicine, Imperial College London, London, UK.
Department of Cardiothoracic Surgery, Liverpool Heart and Chest,
Liverpool, UK
School of Medicine, University of Liverpool, Liverpool, UK
Corresponding author
Amer Harky
MBChB, MRCS, MSc
Department of Cardiothoracic Surgery
Liverpool Heart and Chest Hospital,
Liverpool, UK
Email: aaharky@gmail.com
Disclosure: There are no conflicts of interest or sources of
support
Funding : No funding obtained
Keywords : Myocardial protection, Cardioplegia, Cardiac arrest
Abstract:
For patients undergoing cardiopulmonary bypass, myocardial
protection is a key for successful recovery and improved
outcomes following cardiac surgery that requires cardiac arrest.
Different solutions, components, and modes of delivery have evolved
over the last few decades to optimise myocardial
protection. These include; cold and warm, blood and crystalloid solution
through antegrade, retrograde or combined cardioplegia delivery
approach. However, each method has its own advantages and
disadvantages, posing a challenge to establish a gold
standard cardioplegic solution with an optimised mode of delivery for
enhanced myocardial protection during cardiac surgery.
The aim of this review is to provide a brief history of the development
of cardioplegia, explain the electrophysiological concepts behind
myocardial protection in cardioplegia, analyse the current literature
and summarise existing evidence that warrants the use of varying
cardioplegic techniques. We provide a comprehensive and
comparative overview of the effectiveness of each technique in achieving
optimal cardioprotection and propose novel techniques for optimising
myocardial protection in the future.