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The Journal of Thoracic and Cardiovascular Surgery, Vol 102, 895-903, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
GD Buckberg
The temperature of the heart and the duration of aortic clamping are the
two aspects of myocardial protection that receive the greatest amount of
attention during many cardiac operations. Preoccupation with profound
cardiac cooling has given rise to the development of multiple devices to
keep the heart as cold as possible. This report is written to put into
perspective the roles of hypothermia and aortic clamping in the overall
strategy of myocardial protection. I also wish to (1) suggest that
intraoperative myocardial damage is determined more by "how the heart is
protected" than by "how long the aorta is clamped or how cold the heart is
made," (2) question whether the benefits of deep cardiac hypothermia are
sufficient to offset the monetary costs and morbidity that may result from
its use, and (3) suggest that using all the measures currently available to
prevent, avoid, and reverse ischemic and reperfusion damage is preferable
to preoccupation with profound cardiac cooling.
ARTICLES
Myocardial temperature management during aortic clamping for cardiac surgery. Protection, preoccupation, and perspective
University of California, School of Medicine, Department of Surgery, Los Angeles.
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