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

292 Pages·2011·3.625 MB·English

by  Bruno K. Podesser (auth.), Bruno K. Podesser, David J. Chambers (eds.)

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Bruno K. Podesser
David J. Chambers
Editors
( )
New Solutions for the Heart
An Update in Advanced
Perioperative Protection
SpringerWienNewYork
Prof.Dr.BrunoK.Podesser Dr.DavidJ.Chambers
DepartmentofCardiacSurgery CardiacSurgicalResearch
LandesklinikumSt.Pölten TheRayneInstitute(King’sCollegeLondon)
PropstFührerstr.4 St.ThomasHospital
3100St.Pölten WestminsterBridgeRoad
Austria LondonSE17EH
[email protected] UnitedKingdom
[email protected]
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ISBN978-3-211-85547-8 e-ISBN978-3-211-85548-5
DOI10.1007/978-3-211-85548-5
SpringerWienNewYork
Foreword (by Lawrence H. Cohn)
Thisinterestingvolumeonadvancedperioperativeprotectionduringcardiacsurgeryisan
excellent compilation of past, present and future science of this very important and
fundamentaltopicforeverycardiacsurgeon.
The Editors, Dr. Chambers and Podesser have assembled an all-star cast of excellent
cliniciansandscientists,expertsinthegeneralfieldsofbasiccardiacresearch,cardioplegia
research and clinical outcomes research. After an initial excellent historical chapter the
various authors present much of the basic science of myocyte physiology, myocardial
protection, subjects that have not been well understood. These basic concepts have been
summarizedbeautifullyinthisbookforcliniciansandbasicscienceinvestigatorsalike.
The next section discusses much of what is currently known about the clinical and
physiologicaleffectofcardioplegiaonthebeatingandarrestedheart,theoptimalprotection
forthetransplantedheart,specificrecommendationsforrightheartprotectionandavariety
ofmodalitiestoachieveoptimalprotectioninthesesituations.
Finally, there are several chapters about the potential future of improved protective
cardiac strategies during surgery for an increasing number of patients, particularly the
elderly,whowillrequirecardiacsurgeryoverthenextdecades.Theauthorshavedonean
excellentjobinputtingtogetherthebestofscienceandclinicalpracticeofasubjectwhichis
criticaltosuccessfulcardiacsurgeryandwhichwasputintoeffectonly30yearsagowith
the institution of hyperkalemic cardioplegia. Cardioplegia has become a scientific and
clinicalrequirementforexcellenceinheartsurgery.
Theresultsinheartsurgeryaresuperbtodaycomparedwithyesterdayandabooklike
this is very important to stimulate even better results as we operate on more and more
elderlypatientsandpatientsinextremeheartfailure.Theeditorsaretobecongratulatedon
a superb job of getting the best and the brightest authors and investigators in the area of
myocardialprotectionandinsistingthatwenotstandonourlaurels,butlooktoevenbetter
physiologicandclinicalpathologiccorrelationsforthebestprotectionofheartsduringopen
heartsurgery.
DepartmentofCardiacSurgery LawrenceH.Cohn
TheBrigham&Women’sHospital
HarvardMedicalSchool
Boston,MA,USA
v
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Foreword (by Ernst Wolner)
Myocardialprotectionhasbeenanintegralpartofcardiacsurgeryforthelast40yearsafter
cardiac surgeonshaverealized intheearlydaysthatoperations withoutprotectionof the
heart lead to complications and fatalities. However, the story is not over yet. New chal-
lengesarewaitingforsurgeonsandscientists.Ontheonehand,oursurgicalpopulationis
changingandwearetodayoperatingonolderpatientswithoftenmultipleco-morbidities;
ontheotherhand,weareperformingmorecomplexoperationsthaneverbefore.
Thecurrentbook,editedbyPodesserandChambers,givesanexcellentoverviewonthe
achievementsinmyocardialprotectionofthepast,thecurrentclinicalstrategiesandthefuture
direction of science in this important field of cardiac research. Both Dr. Podesser and
Dr. Chambers have dedicated most of their experimental and clinical work during the last
25 years towards improvement of myocardial protection and helped us to understand basic
conceptsofischemiaandreperfusioninnormalandfailinghearts.Theeditorshaveassembled
the“crèmedelacrème”ofscientistsaroundtheworldthatworkinthisfieldofresearch.The
result is a compendium of excellent contributions that cover the historic development of
cardioplegicarrest.Thenasystematicoverviewofthesitesofinjury,whereinjuryhappens,
ispresented.Aspecialfocusisplacedonageandthepossibleinfluenceofgenderonmyocardial
protectionstrategies.Additionally,duetoincreasingclinicalrelevance,aspotlightisplacedon
protectionoftheright,thefailing,andthetransplantedheart.Inthelastsectionofthebook,new
approachesandtechnologiesarediscussed.Theimportanceoftheendotheliumasthefirstline
ofinjuryanddefense,followedbytheeffectsofcardioplegiaonthevascularsystemandthe
influenceofradicalscavengersarepresented.Finally,alternativesolutionstoarresttheheartare
discussed and new technologies to deliver cardioplegia and/or cell therapies, to improve
perfusionoftheexplantedheartandtovisualizecardioplegiaareproposedtothereader.
Iwouldliketocongratulateallauthorsontheirvaluablecontributionsand,onceagain,
thetwoeditorsforthetremendousworktheyhaveputintothisbook.Thelastcomparable
compendiumis morethan15yearsold. Therefore,this updateinadvancedperioperative
protectionisurgentlyneeded.Theresultsandstrategiespresentedinthisbookwillexpand
ourknowledgeoninjuryandprotectionoftheheartandtherebycanimprovetheoutcome
ofourdailywork.Ithinkitisavaluablebookforbothcardiacsurgeonsandscientists.
DepartmentofCardiothoracicSurgery ErnstWolner
AllgemeinesKrankenhausderStadtWien
MedizinischeUniversitätWien,Vienna,Austria
vii
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Preface
IfIhaveseenalittlefurtheritisbystandingontheshouldersofGiants.
SirIsaacNewton(1643–1727),February5,1676,inalettertoRobertHooke.
Themereformulation ofaproblem is farmore essential than itssolution,whichmay be
merely a matter of mathematical or experimental skills. To raise new questions, new
possibilities, to regard old problems from a new angle requires creative imagination and
marksrealadvancesinscience.
AlbertEinstein,(1879–1955)
Routine work can be accomplished easily and quickly by all who are willing to do so.
However,almosteverybodyhastoundergoatiresometrainingtocarefullyandsystemati-
callyreflectoncomplexprocesses.
Theodor Billroth, (1829–1894) “Über das Lehren und Lernen der medicinischen
WissenschaftenandenUniversitätenderDeutschenNation”Vienna,1876.
The idea for this book was conceived by Bruno Podesser in 2006, after realizing that
therehadbeennocomprehensivesummaryofmyocardialprotectionduringcardiacsurgery
sinceabookeditedbyHMPiperandCJPreussein1993(Ischemia-ReperfusioninCardiac
Surgery).ItbecamemoreofarealitywhenIwasinvitedtogivealectureattheMedical
University,Vienna.Afterwards,wewerechattinginatraditionalKaffeehausintheoldtown
ofViennaandIwaspersuaded(againstmybetterjudgement)tobecomepartoftheproject
as a Co-Editor (and author). This involved help in deciding a structure, and co-opting/
persuading a number of eminent clinicians and scientists in the field of myocardial
protectionassociatedwithcardiacsurgerytowriteachapterrelevanttotheirexpertise.It
also became apparent that there was an expectation to write not one, but two, chapters
(hencemyreservations).Fortunately,theworkinvolvedineditingtheotherchapterswas
maderelativelyeasybytheeruditionofourauthors.
Thatwehavebeensuccessfulinourendeavourcanbeseenwithinthebookthathasnow
beenpublished.Wehopethiswillbeseenasastepping-stoneforcontinuingresearchinthis
field,andasanaidforthechallengesthatarebeforethoseofusinvolvedinmovingcardiac
surgeryforwardasamodernandexcitingspecialtyinmedicine.
ThequotesaboveencapsulatehowwefeelaboutourAuthorsandabouthowwehope
thatthebookwillbeviewed.Ifitcouldactasabasisforfuturestudiesandstimulatemore
research in this field, we would be pleased with the achievement and consider the work
involvedworthwhile.Thequestfornew“solutions”tooptimizeprotectioninallaspectsof
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