Moderne Methoden der Myokardprotektion bei herzchirurgischen Patienten mit akuter myokardialer Ischämie

Summary Currently, coronary bypass operation for acute myocardial ischemia is restricted to patients with recent coronary occlusion resulting from failed PTCA and to patients with mechanical complications of myocardial infarction. The majority of patients suffering acute myocardial infarction are tr...
Ausführliche Beschreibung

Summary Currently, coronary bypass operation for acute myocardial ischemia is restricted to patients with recent coronary occlusion resulting from failed PTCA and to patients with mechanical complications of myocardial infarction. The majority of patients suffering acute myocardial infarction are treated with thrombolytic therapy or PTCA. Revascularization using PTCA or thrombolysis is followed by reperfusion with normal blood at systemic pressure. Despite restoration of perfusion within 6–8 h, this reperfusion modality is associated with reperfusion injury and failure to return segmental contractility. In contrast, coronary artery bypass operation using extracorporeal circulation provides complete unloading of the myocardium and controlled conditions of initial reperfusion as well as of the reperfusate composition. This technique attenuates reperfusion injury and enables early return of segmental contractility in the ischemic area. In the future, surgical revascularization could gain increasing importance as a therapeutic option in the setting of acute myocardial infarction. Prospective, randomized trials comparing thrombolysis, PTCA, and bypass operation are recommended. Ausführliche Beschreibung