Myocardial Protection in Cardiac Surgery—Hindsight From the 2020s

Conventional cardiac surgery is performed using myocardial protection strategies that were developed decades ago. The context of surgery has changed over this period, with patients now who are older and have more comorbidities. However, the systemic effects of cardioplegia solutions have not been a focus of attention. The authors review the biochemical principles of ischemia, reperfusion and cardioplegic extension of ischemia tolerance. In light of rising patient risk profiles, reduction of surgical trauma and improvement of perioperative morbidity is critical. This means considering the systemic effects of cardioplegia solutions, not just the cardiac effects.