New Approaches to Cardioplegia: Alternatives to Hyperkalemia

The current gold standard for cardioplegic arrest during cardiac surgery is to use a hyperkalemic (elevated potassium) solution (either crystalloid or blood-based). Hyperkalemia induces arrest by shifting the resting membrane potential towards a positive value (i.e. a depolarization) and is, therefore, classified as depolarized arrest. Despite its almost universal usage, depolarized arrest has a number of disadvantages that make hyperkalemia, potentially, a less than optimal means of inducing arrest. Thus, alternative arresting methods and agents, which may be beneficial, have been explored. This chapter describes the disadvantages of depolarized arrest and highlights the alternative agents that could possibly be used in a clinical setting to induce alternative means of arrest, discussing their potential advantages and disadvantages.

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