Continuous coronary perfusion with warm ß-blocker-enriched blood has been suggested
as an alternative to cardioplegic arrest for myocardial protection during coronary
artery surgery. The purpose of the present work was 1.) to experimentally inves-tigate
this technique using an animal model, and 2.) to clinically apply this alternative
myocardial protection technique and com-pare it to Standard crystalloid cardioplegia
in a controlled study. We placed 6 dogs on CPB and 6 dogs on a biventricular assist
de-vice and created “ ß-blocker-induced cardiac surgical conditions” by suppressing
myocardial chronotropy and inotropy with sys-temic infusion of the ultra-short acting
ß-blocker esmolol. For the clinical study we randomized 60 coronary artery surgery
pa-tients to receive either crystalloid cardioplegia (Bretschneider HTK) or selective
continuous coronary perfusion via the aortic root with warm esmolol-enriched CPB blood.
In the experimental study we found that continuous coronary perfusion with warm esmolol-enriched
blood avoided myocardial ischemia and mi-nimized myocardial edema, thus completely
preserving cardiac Performance. Our clinical data showed the alternative technique
to be superior to Standard crystalloid cardioplegia in terms of both functional and
structural myocardial protection. The con-cept of ß-blocker-induced cardiac surgical
conditions is a useful alternative for myocardial protection during coronary artery
surgery and may be particularly beneficial for severely com-promised hearts.
Myocardium - Cardioplegia - Edema - Myocardial protection - Coronary disease
