Past and present in myocardial protection

Both the certainty of anatomical repair and early complete recovery of cardiac function are essential elements of successful cardiac surgery. Successful operations require adequate visualization of the operative field, arrest and relaxation of the hearts and sufficient operative time. Extracorporeal circulation and aortic cross-clamping are necessary to maintain a bloodless field. However, interruption of coronary perfusion by the aortic clamp produces myocardial ischemic injury, and unclamping induces reperfusion injury. For years, hypothermia was the most commonly used strategy for myocardial protection. However, the practice of warm heart surgery under normothermic extra corporeal circulation has increased recently. Cardiac surgeons now have a variety of myocardial protection strategies from which to choose. We introduce here the history of myocardial protection and our own recent investigations.