Myocardial Protection

Excerpt

As the field of cardiac surgery progressed, surgeons quickly realized they could not correct or cure complex heart conditions without first halting blood circulation through the heart, allowing them to open it and operate in a bloodless field under direct vision. This understanding led to the development of 2 groundbreaking open-heart surgery techniques. The first, introduced by John Lewis and Mansur Taufic in 1953, utilized the concept of "inflow obstruction." A year later, Walton Lillehei developed the "controlled cross circulation" technique, which proved highly successful in addressing previously inoperable pathologies, such as ventricular septal defect, atrioventricular septal defect, tetralogy of Fallot, and pulmonary stenosis.

Despite their implementation, several unforeseen limitations emerged with these techniques. Surgeons encountered difficulties such as operating on a beating heart, the risk of air embolism when the left side of the heart was exposed, and the challenge of obscured collateral flow from the coronary sinus and pulmonary veins. The need to arrest the heart for successful open-heart surgery became evident, marking the beginning of the era of open-heart surgery. The following is a detailed review of the history, principles, and techniques of myocardial protection, which have evolved to become integral in modern cardiac surgery.