s an alternative to cardioplegic arrest, “cardiac surgical conditions” (i.e. a flaccid
heart which facilitates surgery) have been created by continuously perfusing the coronary
arteries with normothermic blood and suppressing myocardial chronotropy and inotropy
with the ultra-short acting ß-blocker esmolol. In contrast to cardioplegic arrest,
minimal cardiac contraction is maintained. Using this technique, the myocardium is
protected against ischemia by antegrade coronary blood flow and reduced metabolism.
In addition, the presence of minimal cardiac contractions protects the myocardium
against edema formation by maintaining myocardial fluid balance. This paper presents
both the rationale for and the application of “ß-blocker-induced cardiac surgical
conditions” as an alternative concept for myocardial protection during coronary artery
surgery.
Myocardium - Cardioplegia - Edema - Myocardial protection - Coronary disease
