History of Research on Myocardial Protection

Since the early beginnings of cardiac surgery defining the ideal strategy for optimal myocardial protection became the new quest for the Holy Grail for cardiac surgeons worldwide. It was a quest rich in promising hypotheses that often became obsolete and criticised in order only to be readopted a few years later, not only by surgeons, but also by various researchers involved in cardiac physiology and pharmacology. The history of myocardial protection evolved in parallel with the development of new surgical techniques and with the advances in cardiopulmonary bypass that allowed increasingly safe cardiac surgery to be performed. The term myocardial protection includes an entire universe of pharmacological protocols, cardioplegic solutions with their various ways of administration, proper systemic and myocardial temperature control, backed by various devices (intra-aortic balloon pumps, ECLS), and optimal haemodynamic management. However, despite millions of patients operated on worldwide and hundreds of papers published on the subject, there is no universally accepted strategy for myocardial protection. In this chapter we intend to present the birth and the evolution of cardioplegic solutions with their various ways of administration, the existing alternative strategies and how to integrate all these concepts into the era of minimally invasive surgery.