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Protection of the Ischemic Myocardium: Cardioplegia

Alan T. Marty, MD
JAMA. 1982;247(9):1347-1348. doi:10.1001/jama.1982.03320340093053.
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In 1883, Ringer found that the frog heart was inhibited by potassium and stimulated by calcium. Little did he know that nearly a century later we would be doing similar things to more than 200,000 human hearts per year.

This book, collating more than 1,300 references, defines the critical factors that determine cardioplegic actions and efficacy. It delineates many practical guidelines and identifies several areas of uncertainty. And despite the complexity of this subject, the book is written with exemplary clarity.

Myocardial protection stems from two lines of thought: the concept of the reversibility of tissue injury after reperfusion, and the supposition that cellular metabolism can be manipulated to salvage cells that might otherwise have died. The myocardial cell and the surgeon, however, may exhibit conflicting requirements. Cells like blood, while surgeons don't—at least not while they sew. Surgeons like a heart that takes over circulatory work soon after the


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