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Ann Thorac Surg 2003;75:S661-S666
© 2003 The Society of Thoracic Surgeons

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I: Pathophysiology of ischemic-reperfusion injury

Mechanisms and alternative methods of achieving cardiac arrest

^a Cardiac Surgical Research/Cardiothoracic Surgery, The Rayne Institute, Guy’s and St Thomas’ NHS Hospital Trust, St Thomas’ Campus, London SE1 7EH, United Kingdom

* Address reprint requests to Dr Chambers, Cardiac Surgical Research, Cardiothoracic Surgery, The Rayne Institute, Guy’s and St Thomas’ NHS Hospital Trust, St Thomas’ Campus, London SE1 7EH, UK.
e-mail: david.chambers{at}kcl.ac.uk

Presented at the 3^rd International Symposium on Myocardial Protection From Surgical Ischemic-Reperfusion Injury, Asheville, NC, June 2–6, 2002.

Abstract

Elective cardiac arrest during surgery can be achieved by inducing depolarization, polarization, or influencing calcium mechanisms. Depolarized arrest, induced by elevating the extracellular potassium concentration, is currently the most commonly used technique. However, injury associated with ionic imbalance involving sodium and calcium overload, together with maintained metabolic processes aimed at correcting these imbalances, have lead to alternatives being sought. "Polarized" arrest, induced by sodium-channel blockers or by agents that activate potassium channels, has been shown to exert equal or superior protection. Similarly, agents that induce calcium desensitization may also prove to enhance protection. These alternative techniques, however, require extensive characterization before introduction into routine clinical use can be recommended.

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