Sabe Sharif A, Harris Dwight D, Broadwin Mark, Sellke Frank W
Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Rhode Island Hospital, Alpert Medical School of Brown University, 2 Dudley Street, MOC 360, Providence, RI, 02905, USA.
Basic Res Cardiol. 2024 Aug;119(4):545-568. doi: 10.1007/s00395-024-01062-0. Epub 2024 Jun 10.
Since the invention of cardiopulmonary bypass, cardioprotective strategies have been investigated to mitigate ischemic injury to the heart during aortic cross-clamping and reperfusion injury with cross-clamp release. With advances in cardiac surgical and percutaneous techniques and post-operative management strategies including mechanical circulatory support, cardiac surgeons are able to operate on more complex patients. Therefore, there is a growing need for improved cardioprotective strategies to optimize outcomes in these patients. This review provides an overview of the basic principles of cardioprotection in the setting of cardiac surgery, including mechanisms of cardiac injury in the context of cardiopulmonary bypass, followed by a discussion of the specific approaches to optimizing cardioprotection in cardiac surgery, including refinements in cardiopulmonary bypass and cardioplegia, ischemic conditioning, use of specific anesthetic and pharmaceutical agents, and novel mechanical circulatory support technologies. Finally, translational strategies that investigate cardioprotection in the setting of cardiac surgery will be reviewed, with a focus on promising research in the areas of cell-based and gene therapy. Advances in this area will help cardiologists and cardiac surgeons mitigate myocardial ischemic injury, improve functional post-operative recovery, and optimize clinical outcomes in patients undergoing cardiac surgery.
自从体外循环发明以来，人们一直在研究心脏保护策略，以减轻主动脉阻断期间心脏的缺血性损伤以及松开主动脉阻断钳后的再灌注损伤。随着心脏外科手术、经皮技术以及包括机械循环支持在内的术后管理策略的进步，心脏外科医生能够为更复杂的患者实施手术。因此，越来越需要改进心脏保护策略，以优化这些患者的治疗效果。本综述概述了心脏手术中心脏保护的基本原则，包括体外循环背景下心脏损伤的机制，随后讨论了优化心脏手术中心脏保护的具体方法，包括体外循环和心脏停搏的改进、缺血预处理、特定麻醉和药物制剂的使用以及新型机械循环支持技术。最后，将综述在心脏手术背景下研究心脏保护的转化策略，重点关注基于细胞和基因治疗领域的有前景的研究。该领域的进展将有助于心脏病学家和心脏外科医生减轻心肌缺血性损伤，改善术后功能恢复，并优化接受心脏手术患者的临床结局。
