Myocardial protection during ischemia and reperfusion

The objectives of this article are to: (i) discuss the origins and the nature of ischemic injury, (ii) identify factors influencing the evolution of injury, (iii) consider various cellular targets for ischemic injury, (iv) assess the overall importance of 'reperfusion injury', (v) discuss conceptual approaches to cardioprotection and (vi) to identify new ideas and approaches in the realm of myocardial protection. In the human heart, myocardial ischemia may take many forms, it may exist for periods as short as a few seconds or minutes, it may last for hours or it may persist for years. In terms of discussing interventions to combat myocardial ischemia, this article will focus on: (i) regional ischemia as occurs during evolving myocardial infarction and (ii) whole heart or global ischemia as occurs during cardiac surgery and transplantation.