Cardioplegia and myocardial protection: time for a reassessment?

Since the beginnings of open cardiac surgery many different strategies have been introduced to clinical practice in order to provide a motion- and bloodless operation field. Arresting the heart with cardioplegic solutions was described by Melrose and colleagues for the first time (1). Since then cardioplegic solutions have been widely accepted as feasible and safe for the majority of cardiac operations (2). In 1981 Hearse formulated the axioms of myocardial protection during cardiac surgery: firstly cardiac arrest for the conservation of cellular energy storages; secondly hypothermia for the reduction of cellular energy demands; and thirdly application of substances to prevent or reduce ischemia-reperfusion injury (3). These axioms form the foundation for most cardioplegic solutions today.