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Updated: Jul 8, 2025
In vitro Assessment of Myocardial Protection following Hypothermia-Preconditioning in a Human Cardiac Myocytes Model
Published on: October 27, 2020
Myocardial protection in cardiac surgery-hindsight from the 2020s
Murat Mukharyamov1, Ulrich Schneider1, Hristo Kirov1
1Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany.
Insights
Myocardial protection using cardioplegia has advanced cardiac surgery, but current strategies haven't evolved with patient risk. A 2020s perspective highlights the need to consider systemic effects of cardioplegic solutions for improved patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Cardiothoracic Anesthesia
- Biochemistry
Background:
- Cardiac surgery relies on myocardial protection, primarily cardioplegia, to ensure safety during blood flow interruption.
- Established cardioplegia and hypothermia techniques enabled longer cardiac surgeries, with solutions and delivery methods evolving significantly.
- Research interest in myocardial protection has waned since 2000, leaving conventional strategies largely unchanged despite evolving patient demographics.
Purpose of the Study:
- To review the biochemical principles of ischemia, reperfusion, and cardioplegic strategies for extending ischemia tolerance.
- To re-evaluate myocardial protection concepts from a 2020s perspective, considering current patient profiles and surgical challenges.
- To emphasize the importance of addressing the systemic effects of cardioplegic solutions, not just cardiac effects.
Main Methods:
- Literature review of biochemical principles of ischemia and reperfusion.
- Analysis of historical development and current status of myocardial protection strategies in cardiac surgery.
- Evaluation of cardioplegic solutions' systemic effects in the context of modern patient comorbidities.
Main Results:
- Cardiopulmonary bypass and cardioplegia revolutionized cardiac surgery, allowing complex procedures.
- Despite advancements, myocardial protection strategies have stagnated for decades.
- Modern cardiac surgery patients are older with more comorbidities, increasing perioperative risk.
Conclusions:
- Current myocardial protection strategies require re-evaluation due to changes in patient populations and surgical risk profiles.
- Minimizing surgical trauma and managing perioperative morbidity are paramount.
- Future cardioplegia research must consider both cardiac and systemic effects of solutions to optimize patient care.
Abstract:
Myocardial protection and specifically cardioplegia have been extensively investigated in the beginnings of cardiac surgery. After cardiopulmonary bypass had become routine, more and more cardiac operations were possible, requiring reliable and reproducible protection for times of blood flow interruptions to the most energy-demanding organ of the body. The concepts of hypothermia and cardioplegia evolved as tools to extend cardiac ischaemia tolerance to a degree considered safe for the required operation. A plethora of different solutions and delivery techniques were developed achieving remarkable outcomes with cross-clamp times of up to 120 min and more. With the beginning of the new millennium, interest in myocardial protection research declined and, as a consequence, conventional cardiac surgery is currently performed using myocardial protection strategies that have not changed in decades. However, the context, in which cardiac surgery is currently performed, has changed during this time. Patients are now older and suffer from more comorbidities and, thus, other organs move more and more into the centre of risk assessment. Yet, systemic effects of cardioplegic solutions have never been in the focus of attention. They say hindsight is always 20-20. We therefore review the biochemical principles of ischaemia, reperfusion and cardioplegic extension of ischaemia tolerance and address the concepts of myocardial protection with 'hindsight from the 2020s'. In light of rising patient risk profiles, minimizing surgical trauma and improving perioperative morbidity management becomes key today. For cardioplegia, this means accounting not only for cardiac, but also for systemic effects of cardioplegic solutions.
