Dobson, Geoffrey P. (2010) Membrane polarity: a target for myocardial protection and reduced inflammation in adult and pediatric cardiothoracic surgery. Journal of Thoracic and Cardiovascular Surgery, 140 (6). pp. 1213-1217.

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Abstract

The spectrum of opinion regarding the safety, simplicity, clinical application and reversibility of cardioplegia varies from total scepticism and discouragement of its use to advocacy of constant employment with remarkable success. Similar disagreement exists as to which of the cardioplegic agent is the best. —Kaplan and Fisher1 (1959) p. 833

Kaplan and Fisher wrote these edifying words more than 50 years ago, after which there was a 15-year surgeoninstigated moratorium on potassium cardioplegia. Today, more than 2 metric tons of depolarizing potassium are passed through the coronary arteries of 350,000 patients undergoing elective coronary artery bypass graft (CABG) and valvular operations each year in the United States and more than 4 metric tons in more than 800,000 patients in the 2500 cardiac centers worldwide. Despite surgical proficiency and medical innovation driving low in-hospital mortality rates of 1% to 3% for CABG surgery and approximately 6% for valvular surgery, there remains an ongoing challenge to reduce postoperative complications, particularly in older patients with multiple comorbidities and in emergency and redo procedures. Currently, about 10% of patients will have postoperative low cardiac output syndrome, 25% to 40% of CABG patients will have postoperative atrial fibrillation, 4% to 40% may have some form of renal dysfunction, 10%to 40%may have transient cognitive dysfunction and delirium, and of the total number of patients undergoing cardiac surgery at tertiary referral centers 4% to 11% may require prolonged intensive care, which carry significantly higher mortality rates.3,4 The etiology of postoperative complications in adult cardiac surgery or pediatric congenital corrective operations is multifactorial and includes age, gender and ethnicity, cardiopulmonary bypass time, technical difficulty and urgency of the operation, temperature transitions, low preoperative left ventricular ejection fraction, and pre-existing medical conditions such as diabetes, obesity, renal disease, hypertension, and metabolic disorders.

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