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Abstract

The development of cardioplegia has facilitated complex cardiac surgery and allowed high-risk patients to safely tolerate life-saving procedures. By following the principles of electromechanical arrest, inducing hypothermia, and using adjunctive agents to help mitigate the effects of hypothermia and ischemia reperfusion injury, cardioplegia can be safely induced with various commercially available compositions, which can be delivered by several different surgical techniques. Although many studies have compared these methods, there is little consensus on whether any one method is superior to another. Just as a surgeon may need to modify technique according to individual patient factors, so too must a surgeon be flexible and be prepared to use different cardioplegia strategies according to the clinical circumstances. Increasing evidence shows the advantage of coronary artery bypass grafting (CABG) over percutaneous interventions in patients with low ejection fractions. Thus, optimal myocardial protection will continue to be necessary in this higher-risk cohort. Moreover, while patients in cardiogenic shock rarely present for CABG, the high mortality in this cohort demonstrates the need for ongoing efforts to improve myocardial protection. Lastly, there may be circumstances in which alternative approaches involving fibrillatory arrest or keeping the heart beating are more effective than conventional cardioplegia. These techniques should all be part of the surgeon’s armamentarium, enabling the surgeon to tailor the operation to the individual patient.

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