Myocardial Protection During Cardiac Surgery

Adequate myocardial protection is an integral part of the safe conduct of cardiac surgery. The mainstay of myocardial protection is cardioplegia. Since the concept of reversible chemically-induced cardiac arrest was first introduced in the 1950s, a number of different cardioplegic solutions have been developed. As a result, there is wide variability in clinical practice and, despite the publication of numerous comparative clinical studies, there is no clear consensus regarding the optimal strategy for myocardial protection in adult cardiac surgery. In this chapter, we briefly survey the history of myocardial protection. We describe the main types of cardioplegic solutions currently available, and discuss controversies surrounding optimal temperature and method of delivery, highlighting the advantages and limitations of various approaches. Finally, we briefly discuss the emerging evidence regarding novel strategies for myocardial protection using single-dose solutions.