Myocardial protection: entering the new millennium

Dual objectives at operation are technical success and absence of iatrogenic injury due to inadequate myocardial protection. We enter a new millennium, and the spectrum of surgical procedures used to correct abnormal structure is expanding. We need longer intervals of aortic clamping to make the correct diagnosis, and to implement a more natural correction (i.e., mitral valve repair, Ross procedure, aortic recontruction with stentless valves, homografts). Simultaneously, our patients have increased vulnerability to injury, so that growth is needed to advance our methods of protection, in the same way as we learn new operative techniques. This manuscript deals both with evolution of current methods and recognition of newer methods of protection, so that the dual relationship between protection and procedures will not separate.