Anesthesiology and Intensive Care

After establishing cardiopulmonary bypass (CPB) with the perfusate at 32°C—ensuring that ventricular fibrillation does not occur—a catheter is inserted into the aortic root through a previously placed purse-string stitch, attached to the cardioplegia line, and de-aired. Optionally, the pressure line of the catheter can be connected to a strain gauge for continuous monitoring of aortic root pressure. The aorta is clamped once the aortic root catheter is in place and certainly before the heart has cooled enough from whole-body perfusion to become arrhythmic or develop ventricular fibrillation .

Energy conservation during myocardial ischemia can be achieved by inducing chemical arrest through two primary mechanisms: Preventing the conduction of the myocardial action potential by inhibiting the fast sodium current can be achieved through one or more of the following methods :

Both β-adrenergic receptor blockers and calcium channel blockers, when used alongside other methods, have been incorporated into myocardial management strategies by various groups. Calcium channel blockers such as verapamil and diltiazem are particularly beneficial due to their ability to prevent calcium entry into cells and their coronary vasodilatory effects. However, these drugs are also strong negative inotropes and cause prolonged electromechanical inactivity, especially when used in cardioplegic solutions.

Moderately Hypothermic Intermittent Global Myocardial Ischemia Intermittent cardiac ischemia with moderate cardiac hypothermia requires performing cardiopulmonary bypass (CPB) with a perfusate temperature between 25°C and 30°C. During this method,

Continuous Normokalemic Coronary Perfusion: Empty Beating Heart Early intracardiac procedures were performed on normothermic, perfused, empty beating hearts. Experimental studies initially suggested that this method maintained "normal left ventricular function" for up to 3 hours of cardiopulmonary bypass (CPB) with the heart empty and

 "Off-pump" coronary bypass bypass surgery (OPCAB) was developed in response to concerns regarding the potential side effects of CPB. The goal of this procedure is to achieve total revascularization while avoiding CPB. Positioning the heart for transplantation without compromising hemodynamics is achieved with the use of several retraction devices and deep pericardial sutures. A platform that provides stability reduces movement at the arteriotomy site. After performing an arteriotomy, ischemia can be reduced via intracoronary or aortocoronary shunting.