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Myocardial protection in cardiac surgery: how limited are the options? A comprehensive literature review
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  • Abigail Whittaker,
  • Maryam Aboughdir,
  • Samiha Mahbub,
  • Amer HarkyOrcid
Abigail Whittaker
St. George University of London
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Maryam Aboughdir
St. George University of London
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Samiha Mahbub
St. George University of London
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Amer Harky
Orcid
Liverpool Heart and Chest Hospital NHS Foundation Trust
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Abstract

For patients undergoing cardiopulmonary bypass, myocardial protection is a key for successful recovery and improved outcomes following cardiac surgery that requires cardiac arrest. Different solutions, components, and modes of delivery have evolved over the last few decades to optimise myocardial protection. These include; cold and warm, blood and crystalloid solution through antegrade, retrograde or combined cardioplegia delivery approach. However, each method has its own advantages and disadvantages, posing a challenge to establish a gold standard cardioplegic solution with an optimised mode of delivery for enhanced myocardial protection during cardiac surgery. The aim of this review is to provide a brief history of the development of cardioplegia, explain the electrophysiological concepts behind myocardial protection in cardioplegia, analyse the current literature and summarise existing evidence that warrants the use of varying cardioplegic techniques. We provide a comprehensive and comparative overview of the effectiveness of each technique in achieving optimal cardioprotection and propose novel techniques for optimising myocardial protection in the future.