MYOCARDIAL PROTECTION FOR CORONARY-BYPASS GRAFTING - THE TORONTO HOSPITAL PERSPECTIVE

Background. The contemporary results of coronary artery bypass grafting using a variety of myocardial preservation techniques are excellent. In recent years, the number of ''high-risk'' patients referred for operation has increased, thus necessitating continued advances in surgical myocardial protection. Methods. In this article, we review recent advances in clinical myocardial protective techniques and emphasize studies conducted at The Toronto Hospital. Further, on the basis of promising current research, we speculate on future prospects for myocardial protection. Results. At The Toronto Hospital, we converted from crystalloid to intermittent cold blood cardioplegia in 1985. We demonstrated that ''continuous'' cardioplegic strategies may help resuscitate the ischemic myocardium and reduce operative complications in high-risk patients. Further improvements in myocardial protection will require refinements in cardioplegic solution temperature, direction of delivery, and additives to ''precondition'' the myocardium against ischemic damage. Conclusions. Major advances that meet the requirements of an increasingly high risk patient population have been made in surgical myocardial protection in recent years. The future is bright for continued progress in this area.