NEW STRATEGIES IN MYOCARDIAL PRESERVATION

Myocardial protection seems to be evolving toward simplified technique s, among which the use of minimally diluted tepid blood cardioplegia d elivered retrograde or in a combined fashion is gaining wider clinical acceptance. In the future, agents that can duplicate the cardioprotec tive effects of ischemic preconditioning, prevent the cell-damaging ca lcium overload by inhibition of the sodium-hydrogen exchanger, and pre serve endothelial function hold the greatest promises. The concept of hyperpolarized arrest (as opposed to the conventional potassium-induce d depolarized arrest) also might be a breakthrough if it becomes clini cally feasible. Finally, beating-heart (coronary) surgery without aort ic cross-clamping possibly could be the ultimate form of myocardial pr otection, in particular if the inflammatory effects of cardiopulmonary bypass that adversely affect cardiac function can be mitigated by new developments in biomaterials and appropriate drug therapies.