New Solutions for the Heart: An Update in Advanced Perioperative Protection

New Solutions for the Heart: An Update in Advanced Perioperative Protection......Page 1
Front-matter......Page 2
New Solutions for the Heart......Page 4
Copyright......Page 5
Foreword (by Lawrence H. Cohn)......Page 6
Foreword (by Ernst Wolner)......Page 8
Preface......Page 10
Contents......Page 12
Contributors......Page 14
Part I\rIntroduction......Page 18
1.1 Historic Development and Current Trends in Cardiac Surgery......Page 19
1.2 The Rightward Shift of the Age Curve: Representative Examples for Major Procedures......Page 20
1.3 Early Mortality in the 1990s and in 2010......Page 21
1.4.1 Standardization of Procedures......Page 22
1.4.3 Partners......Page 23
1.5.1 Bi-Directional Education......Page 24
1.5.2 New Concepts......Page 25
References......Page 26
Part II\rFundamentals......Page 29
2.1.1 Background and Definitions......Page 31
2.1.3 Survival and Success......Page 33
2.1.3.1 Bretschneider and Söndergaard......Page 34
2.1.3.2 International Reawakening......Page 35
2.1.3.3 British Rediscoveries......Page 37
2.2 Concepts and Issues......Page 38
2.2.1.1 Rescucitation Time......Page 39
2.2.1.2 The Stone Heart Challenge......Page 40
2.2.2.1 Hypothermia on Its Own......Page 41
2.2.2.2 Hypothermia Plus Cardioplegia......Page 42
2.2.3.1 Calcium Takes Centre Stage......Page 43
2.2.3.3 Ionic Interactions and Calcium Control......Page 44
2.2.4 Reperfusion......Page 47
2.2.5 Blood as Cardioplegic Vehicle......Page 48
2.3 Summary and Closing Remarks......Page 50
References......Page 51
3.2 Ischaemic Heart Disease......Page 57
3.2.2.1 Cytoplasmic Effects......Page 58
3.2.2.2 Mitochondria Effects......Page 60
3.2.3 Oxidative Injury During Ischaemia-Reperfusion......Page 61
3.3.1 Myocyte Signalling Pathway Changes......Page 64
3.3.2 Myocyte Metabolic Changes......Page 65
3.4.1 Endogenous Protection: Preconditioning and Postconditioning......Page 66
References......Page 68
4.1 Introduction......Page 73
4.2.2 Acutely Inflamed Endothelium......Page 74
4.2.3 Chronically Inflamed Endothelium......Page 76
4.3.1 Endothelial Dysfunction: Definition......Page 77
4.3.3 Oxidative Stress as the Underlying Mechanism of Endothelial Dysfunction......Page 78
4.5.1 Inflammatory Activation of the Endothelium During Cardioplegia......Page 79
4.5.3 Endothelial Cell Apoptosis and Cardiac Surgery......Page 80
References......Page 81
Part III\rSpecial Focus......Page 87
5.1.1 Myocardial Protection in the Aged......Page 89
5.1.2 Myocardial Ischemia/Reperfusion Injury......Page 90
5.1.3 Apoptosis in Myocardial Ischemia/Reperfusion Injury......Page 91
5.1.5 Morphological Alterations in Ischemia/Reperfusion Injury......Page 92
5.1.6 Mitochondrial Alterations in Ischemia/Reperfusion Injury......Page 94
5.2 Cardioprotection......Page 96
5.3 Effects of Age and Gender in Ischemia/Reperfusion Injury......Page 99
5.5 Female Age and the Role of Estrogen......Page 100
5.6 Future Directions for the Amelioration of Ischemia/Reperfusion Injury......Page 101
References......Page 102
6.1 Introduction......Page 109
6.2 Physiology of the Right Ventricle......Page 110
6.3.1 Effects of an Elevation of Right Ventricular Afterload......Page 111
6.3.2 Ventricular Interdependence......Page 114
6.3.4 Right Ventricular Infarction......Page 115
6.4.2 Echocardiography......Page 116
6.5.2 Fluid Management......Page 117
6.5.5 Inotropes......Page 118
6.5.6 Vasopressors......Page 119
6.6 Conclusions......Page 120
References......Page 121
7.1 Background and Definition......Page 125
7.3.1 LaPlaces Law......Page 126
7.4.1 Vascular Dysfunction......Page 127
7.4.2.2 The Endothelin System......Page 128
7.4.3.1 Reduction of Shear Stress......Page 129
7.5.1 Theoretical Rationale Behind Revascularization......Page 130
7.5.2 Coronary Artery Bypass Graft Surgery Versus Medical Therapy......Page 131
7.5.4 Viability Testing......Page 132
7.6.1 Aortic Stenosis and Severely Reduced LV Function......Page 133
7.6.2 Aortic Regurgitation and Severely Reduced LV Function......Page 134
7.6.3 Mitral Valve Surgery and Severely Reduced LV Function......Page 135
7.7.2 Optimizing Temperature of Cardioplegia......Page 136
7.7.3 Cardioplegia Beyond Myocardial Protection: The Need of Endothelial Protection......Page 137
7.7.4 Mechanical Considerations......Page 139
7.7.5 Perioperative Conditioning of the Heart......Page 140
References......Page 141
8.1 Background: Heart Transplantation in the Current Era......Page 147
8.2 Minimising Myocardial Damage......Page 148
8.2.1.2 Haemodynamic Instability and Cushing Response......Page 149
8.2.1.3 Noradrenaline in Donor Resuscitation......Page 150
8.2.1.5 Heart Preservation During the Cold Ischaemic Period......Page 151
8.2.1.6 Safe Storage for Transportation......Page 152
8.2.1.7 Warm Ischaemic Time......Page 153
8.3 Results: Outcome of Cardiac Transplantation......Page 154
8.5 Summary......Page 155
References......Page 156
Part IV\rNew Approaches and Technologies......Page 159
9.1 Introduction......Page 161
9.2 NO Pathway......Page 162
9.3 Endothelium Dysfunction During I/R......Page 164
9.4 Clinical State-of-the-Art to Preserve the Heart During Cardiac Surgery and Transplantation......Page 165
9.5.1.1 Radical Scavengers......Page 166
9.5.1.3 ACE Inhibitors and Bradykinin......Page 168
9.5.1.4 Endothelin Receptor Antagonists......Page 169
9.5.2.1 l-Arginine......Page 170
9.5.3 NO-Releasing Compounds......Page 171
9.6 Discussion......Page 174
9.7 Summary......Page 175
References......Page 176
10.1 Introduction......Page 183
10.2.1 Nitric Oxide Synthase......Page 184
10.2.3 Cyclooxygenase......Page 185
10.2.5 Protein Kinase Pathways......Page 186
10.3 Clinical Perspective......Page 188
10.4 Conclusion......Page 189
References......Page 190
11.1 Ischemia-Reperfusion Injury......Page 195
11.1.1 Reactive Oxygen Species......Page 196
11.1.2 Reactive Nitrogen Species......Page 198
11.1.5 Summary......Page 199
11.2.1 N-acetylcysteine......Page 200
11.2.2 Allopurinol......Page 202
11.2.3 Vitamin E and C......Page 203
11.2.4.1 Deferoxamine......Page 205
11.3 Summary......Page 206
References......Page 208
12.2 The Induction of Arrest......Page 215
12.2.1 The Physiology of Excitation-Contraction Coupling......Page 216
12.3.1.1 Extracellular Hyperkalemia (Depolarized Arrest)......Page 218
12.3.1.2 Hyperpolarization/Polarization (Potassium Channel Openers)......Page 220
12.3.2 Direct Blockade of Sodium Channel Activation (Sodium Channel Blockers)......Page 222
12.4.1 Hypocalcemia......Page 224
12.4.2 Direct Blockade of Cell Membrane Calcium Channels (Calcium Channel Blockers)......Page 225
12.4.3 Direct Myofilament Inhibition (Calcium Desensitization)......Page 226
12.5 Inhibition of Multiple Cellular Targets......Page 227
12.5.1 Direct Blockade of Both Sodium and Calcium Channels (eg. Esmolol)......Page 228
References......Page 229
13.1 Introduction......Page 237
13.2 Perioperative Myocardial Protection Via Coronary Sinus......Page 238
13.2.1.1 Access to the Coronary Sinus......Page 239
13.2.2 Retrograde Cardioplegia......Page 240
13.3.1 Anterograde Intracoronary Cell Transplantation......Page 244
13.3.2.1 Adenosine, Nicorandil......Page 247
13.3.2.4 Post-Conditioning......Page 248
13.4 Retrograde Transplantation of Stem Cells and Retroinfusion of Cardioprotective Substances Into Ischemic Myocardium: More t......Page 249
13.4.1 Transvenous Intracoronary Route for Cell Transplantation and Gene/Protein Delivery......Page 250
13.4.1.1 Experimental Studies on Transvenous Intracoronary Cell Transplantation......Page 251
13.4.1.3 Gene and Protein Delivery via Coronary Venous System......Page 253
13.5 Exceptional Role of Pressure in the Hemodynamics of Coronary Sinus Interventions......Page 254
13.5.1 Arterialization of Coronary Veins......Page 255
13.5.2 Pulsatile Cardioplegia......Page 256
13.5.3 Controlled Pressure Elevation in the Coronary Sinus: A Common Denominator of Coronary Sinus Interventions......Page 257
13.6 Conclusion......Page 258
References......Page 259
14.1 Introduction......Page 265
14.3 Rationale of Continuous Machine Perfusion......Page 266
14.5 History of Normothermic Oxygenated Blood Perfusion......Page 267
14.6 History of Hypothermic Oxygenated Blood Perfusion......Page 268
14.8.1 Cold Perfusion Concept and Mechanism of Protection......Page 269
14.8.4 Perfusate Oxygenation......Page 270
14.8.6 Effects of Hypothermic Oxygenated Perfusion Tested in Transplant Models......Page 271
14.8.8 Disadvantages of Hypothermic Oxygenated Perfusion......Page 272
14.9.2 Perfusion Route......Page 273
14.9.5 Perfusate Composition......Page 274
14.9.7 Advantages of Normothermic Oxygenated Perfusion......Page 275
14.9.9 Clinical Data......Page 276
14.10 Conclusion......Page 277
References......Page 278
15.1 Introduction......Page 285
15.2.2 Characteristics of Ultrasound Contrast Agents......Page 286
15.2.3 Data Acquisition and Analysis......Page 287
15.2.4 Limitations......Page 289
15.3 Near-Infrared Fluorescence Imaging......Page 290
15.3.2 Fluorescent Dyes and Their Characteristics......Page 291
15.3.3 Data Acquisition and Analysis......Page 292
15.3.4 Limitations......Page 294
References......Page 295
Author Index......Page 299
Subject Index......Page 301