Cardioplegia and Calcium Antagonists: A Review

During open-heart operations, periods occur during which the blood supply to the heart is stopped. Myocardial damage can be limited by cooling and induction of electromechanical arrest (cardioplegia). Many animal studies and some clinical trials provide strong evidence for the use of calcium antagonists, such as nifedipine, verapamil hydrochloride, diltiazem hydrochloride, and lidoflazine, as adjuncts to cardioplegia to optimize the protection. Salutary effects of calcium antagonists are discussed in regard to possible mechanism of action, application time, and efficacy during hypothermia. A major conclusion is that virtually no negative effects on cardiac protection have as yet been described in experimental or clinical studies, apart from short-term negative inotropic responses, while there is an increasing body of positive evidence for their efficacy. A new development is the use of these drugs for regional cardioplegia during dilation of coronary arteries (transluminal angioplasty).