TY - CHAP M1 - Book, Section TI - Chapter 15. Myocardial Protection A1 - Mentzer, Jr., Robert M. A1 - Gottlieb, Roberta A. A1 - Przyklenk, Karin A1 - Jahania, M. Salik A2 - Cohn, Lawrence H. Y1 - 2012 N1 - T2 - Cardiac Surgery in the Adult, 4e AB - In the setting of heart surgery, myocardial protection refers to strategies and methodologies used in the operating room to attenuate or prevent perioperative infarction and/or postischemic ventricular dysfunction. This is in contrast to the instance in which a patient presents with an acute myocardial infarction (MI). Here the objective is to reduce infarct size at reperfusion. The underlying pathophysiology in both settings, however, relates to the etiology and consequences of ischemia-reperfusion injury. After surgery the injury manifests by low cardiac output, hypotension, and a need for postoperative inotropic support. The damage may be reversible or irreversible and is differentiated by the presence of electrocardiographic abnormalities, elevations in the levels of specific plasma enzymes or proteins such as creatine kinase and troponin I or T, and/or the presence of regional or global echocardiographic wall motion abnormalities. Depending on the criteria, the incidence of postoperative MI after CABG surgery ranges between 3% and 18%. The incidence of severe ventricular dysfunction, heart failure, and death, despite advances in surgical techniques, ranges between 2 and 15%; the higher mortality rates are associated with high-risk patients with minimal cardiac reserve. SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/03/29 UR - accesssurgery.mhmedical.com/content.aspx?aid=55915028 ER -