[Myocardial protection: the current status and the future prospect]

Perioperative myocardial damage remains the most common cause of morbidity and death following technically successful cardiac operations. Such damage is caused by an imbalance between myocardial energy demand and supply occurring before, during, and after extracorporeal circulation. Meanwhile, since the advent of cardiac surgery, improved methods have been studied to provide a safe, quiet, and bloodless operative field. In recent years, much effort has been devoted to experimental and clinical research to improve myocardial protection during open heart surgery. With understanding on the pathophysiology of ischemic myocardium and reperfusion injury etc. significant advances have been made in myocardial protection during open heart operation, which has allowed a significant reduction in perioperative myocardial injury. In this article, recent developments in myocardial protection and currently accepted clinical techniques have been presented. Furthermore, it has been discussed to concentrate on current topics of controversy and new investigations in this field. Although some cardiac surgeons would argue that very little advanced new information is available in myocardial protection during open heart operation, my opinion is "no". Still now, there are many remained, important problems, such as 1) protective method of immature neonatal myocardium 2) effective substrates to facilitate high energy resumption, and specific scavengers to modify oxygen free radical during reperfusion, and so on. We should expect and await further experimental and clinical trials.