Myocardial protection and cardioplegia

Over the past year there has been a tremendous enthusiasm for the novel technique of warm heart surgery. In contradistinction to hypothermic myocardial preservation, warm cardiac surgery provides for operative repair in a nonischemic heart. Warm cardioplegia can be administered in an antegrade or retrograde manner, continuously, and perhaps even intermittently. It may have beneficial effects on systemic perfusion and may be a useful adjunct in the setting of acute cardiac ischemia. There likewise has been a burgeoning enthusiasm for the retrograde cardioplegic delivery route. Many reviews of clinical work using both warm and cold retrograde cardioplegia have identified the advantage of this technique, particularly in the setting of valve replacement and reoperation for coronary revascularization. Finally, new avenues of investigation in ischemia and reperfusion including inquiry into the role of neutrophils in reperfusion injury and modification of the reduced thiol pool to modulate the postischemic burst of oxygen-free radical production.