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Ann Thorac Surg 2001;72:S2220-S2226
© 2001 The Society of Thoracic Surgeons

Supplement: Monitoring and improving patient safety during and following cardiac surgery

Intraoperative metabolic monitoring of the heart: I. Clinical assessment of coronary sinus metabolites

Michael D. Crittenden, MD*a

a Department of Surgery, VA Boston Healthcare System, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

* Address reprint requests to Dr Crittenden, Surgical Service (112), VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA
e-mail: michael.crittenden{at}med.va.gov

Presented at Monitoring and Improving Patient Safety During and Following Cardiac Surgery, San Diego, CA, May 5, 2001.

Abstract

Numerous clinical studies have corroborated the ability of intraoperative sampling of coronary sinus blood to measure changes in myocardial metabolism induced by ischemia and reperfusion. Among other changes, cardiac arrest induces a period of obligate myocardial lactate production that persists for an indeterminate amount of time after reperfusion. Coronary sinus lactate assays have been established as a standard method to compare various myocardial protection strategies. Current methodology requires detailed sample processing, precluding real-time feedback in the operating room. Newer devices hold promise in allowing the online assessment of myocardial metabolism; however, these methods await precise validation.




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