Future Directions

Future research in myocardial protection will most likely focus on high risk patients where operative procedures continue to result in significant cardiac morbidity and mortality. Ischemic preconditioning is the most powerful endogenously-mediated form of myocardial protection, but is difficult to apply clinically. Pharmacologic additives, such as adenosine, nicorandil, or nitric oxide precursors may be able to reproduce the effects of ischemic preconditioning. Restoration of aerobic myocardial metabolism through agents such as insulin and dichloroacetic acid offers another potential mechanism of myoprotection. These agents are currently undergoing rigorous evaluation at Toronto General Hospital and other investigative centers.

Selected Readings

1. Rao V, Cohen G, Weisel RD et al. Optimal flow rates for integrated cardioplegia. J Thorac Cardiovasc Surg 1998; 115:226-235.

2. Yau TM, Ikonomidis JS, Weisel RD et al. Which techniques of cardioplegia prevent ischemia? Ann Thorac Surg 1993; 56:1020-1028.

3. Cohen G, Borger MA, Weisel RD et al. Intraoperative myocardial protection: Current techniques and future perspectives. Ann Thorac Surg 1998; (In press).

4. The Warm Heart Investigators. Randomised trial of normothermic versus hypothermic coronary bypass surgery. Lancet 1994; 343:559-63.

5. Hayashida N, Weisel RD, Shirai T et al. Tepid antegrade and retrograde cardiople-gia. Ann Thorac Surg 1995; 59:723-729.

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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