Publication

Hyperkalemic cardioplegia for adult and pediatric surgery: end of an era?

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Last modified
  • 05/21/2025
Type of Material
Authors
    Geoffrey P. Dobson, James Cook UniversityGiuseppe Faggian, University of VeronaFrancesco Onorati, University of VeronaJakob Vinten-Johansen, Emory University
Language
  • English
Date
  • 2013-01-01
Publisher
  • Frontiers Media SA
Publication Version
Copyright Statement
  • © 2013 Dobson, Faggian, Onorati and Vinten-Johansen.
Final Published Version (URL)
Title of Journal or Parent Work
Volume
  • 4
Start Page
  • 228
End Page
  • 228
Grant/Funding Information
  • The authors would like to thank the National Health and Medical Research grant 540409 (Geoffrey P. Dobson) for financial support for part of this study.
Abstract
  • Despite surgical proficiency and innovation driving low mortality rates in cardiac surgery, the disease severity, comorbidity rate, and operative procedural difficulty have increased. Today's cardiac surgery patient is older, has a "sicker" heart and often presents with multiple comorbidities; a scenario that was relatively rare 20 years ago. The global challenge has been to find new ways to make surgery safer for the patient and more predictable for the surgeon. A confounding factor that may influence clinical outcome is high K(+) cardioplegia. For over 40 years, potassium depolarization has been linked to transmembrane ionic imbalances, arrhythmias and conduction disturbances, vasoconstriction, coronary spasm, contractile stunning, and low output syndrome. Other than inducing rapid electrochemical arrest, high K(+) cardioplegia offers little or no inherent protection to adult or pediatric patients. This review provides a brief history of high K(+) cardioplegia, five areas of increasing concern with prolonged membrane K(+) depolarization, and the basic science and clinical data underpinning a new normokalemic, "polarizing" cardioplegia comprising adenosine and lidocaine (AL) with magnesium (Mg(2+)) (ALM™). We argue that improved cardioprotection, better outcomes, faster recoveries and lower healthcare costs are achievable and, despite the early predictions from the stent industry and cardiology, the "cath lab" may not be the place where the new wave of high-risk morbid patients are best served.
Author Notes
  • Correspondence: Geoffrey P. Dobson, Department of Physiology and Pharmacology, Heart and Trauma Research Laboratory, James Cook University, Townsville, QLD4811, Australia e-mail: geoffrey.dobson@jcu.edu.au
Keywords
Research Categories
  • Health Sciences, Medicine and Surgery

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