Cardiac Protection during Open Heart Surgery: A View from Coronary Endothelial Function / 中山大学学报(医学科学版)

ABSTRACT

Cardioplegic (and organ preservation) solutions were initially designed to protect the myocardium (cardiac myocytes) during cardiac surgery (and heart transplantation). Due to the differences between the cardiac myocytes and vascular (endothelial and smooth muscle) cells in structure and function, the solutions may have adverse effect on coronary vascular cells. However, such effect is often complicated by many other factors such as ischemiareperfusion injury, temperature, and perfusion pressure or duration. In evaluation of the effect of a solution on the coronary endothelial function, a number of points should be taken into consideration. First, the overall effect on endothelium should be identified. Second, the effect of the solution on the individual endothelium-derived relaxing factors (nitric oxide, prostacylin, and endothelium-derived hyperpolarizing factor) must be distinguished. Third, the effect of each major component of the solution should be investigated. Fourth, the effect of a variety of new additives in the solution may be studied. In the last decades, we have focused our research on the endothelial function during open heart surgery and have for the first time found that high potassium concentration impairs the EDHF-mediated function. This review attempts to discuss the above issues based on available literature in order to provide information for further development of cardioplegic or organ preservation solutions.