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Current Approaches to Prevention and Management of Reperfusion Injury

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Book cover Management of Myocardial Reperfusion Injury

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Abstract

As our understanding of the pathophysiological underpinnings of reperfusion injury has increased, many therapies directed at preventing the detrimental effects of this phenomenon have been tested. For primary PCI, this has ranged from mechanical protection from distal embolization of plaque material, preventing calcium overload after reperfusion, to the inhibition of specific inflammatory mediators. Although most have shown promise in smaller mechanistic clinical trials, only mechanical thrombectomy has thus far been shown to be of clinical benefit in larger investigations.

Additionally, the occurrence of ventricular arrhythmias poses a threat not only due to (1) electrical failure and subsequent asystole but also because (2) bursts of ventricular activity around the time of reperfusion signify a larger infarct size and subsequent long-term risk of pump failure. Prophylactic treatment with antiarrhythmic drugs has thus far been shown to increase mortality, and investigations are ongoing to improve our understanding of these arrhythmias and to identify patients at high risk that may benefit from treatment.

For the prevention of reperfusion injury in coronary artery bypass grafting, the optimum combination of cardioplegic solutions and temperature has not yet been determined. No regimen has been shown to confer superior myocardial salvage over another, with cold blood crystalloid infusion having become the most used worldwide. As in primary PCI, the search continuous for specific cardioprotective compounds and identifying patients at high risk to optimize treatment strategies.

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Authors and Affiliations

  1. Department of Cardiology, Academic Medical Center – University of Amsterdam, Room B2-213, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands

    Wichert J. Kuijt M.D.

  2. Department of Surgery, Division of Cardiac Surgery, Duke University, 2405 Englewood Ave., Durham, 27705, NC, USA

    Judson Williams M.D., MHS

  3. Department of Cardiology, Division of Cardiovascular Medicine, Duke University Medical Center, Duke Clinical Research Institute, 2400 Pratt St., 27705, Durham, NC, USA

    Christopher B. Granger M.D.

  4. Department of Medicine, Division of Cardiology, Duke University Medical Center, 508 Fulton Street, Room A3006 Cardiology, Durham, NC, 27705, USA

    Mitchell W. Krucoff M.D., FACC, FAHA

  5. Division of Cardiovascular Medicine, Duke University Medical Center, Duke Clinical Research Institute, 2400 Pratt St., Room 7035, Durham, NC, 27705, USA

    Matthew T. Roe M.D., MHS

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  1. Wichert J. Kuijt M.D.
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  2. Judson Williams M.D., MHS
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  3. Christopher B. Granger M.D.
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  4. Mitchell W. Krucoff M.D., FACC, FAHA
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  5. Matthew T. Roe M.D., MHS
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Correspondence to Matthew T. Roe M.D., MHS .

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Editors and Affiliations

  1. Medical School, Coronary Artery Disease, Research Group, St George's Hospital, Cranmer Terrace, London, SW17 0RE, United Kingdom

    Juan Carlos Kaski

  2. Hatter Cardiovascular Inst., Div. Medicine, University College London, Chenies Mews 67, London, WC1E 6HX, United Kingdom

    Derek J. Hausenloy

  3. Mayo Graduate School of Medicine, Dept. Cardiovascular Diseases, Mayo Clinic, First Street SW. 200, Rochester, 55905, Minnesota, USA

    Bernard John Gersh

  4. Hatter Cardiovascular Institute, University College London, Chenies Mews 67, London, WC1E 6HX, United Kingdom

    Derek M. Yellon

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Kuijt, W.J., Williams, J., Granger, C.B., Krucoff, M.W., Roe, M.T. (2012). Current Approaches to Prevention and Management of Reperfusion Injury. In: Kaski, J., Hausenloy, D., Gersh, B., Yellon, D. (eds) Management of Myocardial Reperfusion Injury. Springer, London. https://doi.org/10.1007/978-1-84996-019-9_10

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