MYOCARDIAL PROTECTION FOR CORONARY-BYPASS GRAFTING - THE TORONTO HOSPITAL PERSPECTIVE

Background. The contemporary results of coronary artery bypass graftin g using a variety of myocardial preservation techniques are excellent. In recent years, the number of ''high-risk'' patients referred for op eration has increased, thus necessitating continued advances in surgic al myocardial protection. Methods. In this article, we review recent a dvances in clinical myocardial protective techniques and emphasize stu dies conducted at The Toronto Hospital. Further, on the basis of promi sing current research, we speculate on future prospects for myocardial protection. Results. At The Toronto Hospital, we converted from cryst alloid to intermittent cold blood cardioplegia in 1985. We demonstrate d that ''continuous'' cardioplegic strategies may help resuscitate the ischemic myocardium and reduce operative complications in high-risk p atients. Further improvements in myocardial protection will require re finements in cardioplegic solution temperature, direction of delivery, and additives to ''precondition'' the myocardium against ischemic dam age. Conclusions. Major advances that meet the requirements of an incr easingly high risk patient population have been made in surgical myoca rdial protection in recent years. The future is bright for continued p rogress in this area.