Organschutz und kardioplegische Lösungen

The development of a sophisticated myocardial protection technique was an important catalyst in the evolution of modern cardiovascular surgery. Organ preservation solutions were designed to attenuate the detrimental effects during the ischemic period. Despite the increasing popularity of single dose cardioplegic techniques in open heart surgery, the time window for successful reperfusion remains unclear. A single cardioplegia shot can protect the myocardium for more than 90 min of the cross-clamping time. This feature is especially attractive for longer and more complex procedures because it eliminates interruptions during surgery to repeat the administration of cardioplegia that is required for extracellular cardioplegia. Only limited data exist that compare the established solutions for preservation of the heart with single shot techniques. This review article provides an overview of the current status and future implications for organ protection and long acting cardioplegia strategies and mainly refers to the recent comparative clinical/experimental research of the authors. The data demonstrate the impact of a histidine-tryptophan-ketoglutarate solution on the long-term efficacy of cardioprotection and cardioplegic techniques that could become more crucial in high-risk patients who genuinely have a chance to benefit from adjunct myocardial preservation.