title: Cardioprotection: a review of current practice in global ischemia and future translational perspective.
abstract: The idea of protecting the heart from ischemic insult during heart surgery to allow elective cardiac arrest is as old as the idea of cardiac surgery itself. The current gold standard in clinical routine is a high potassium regimen added either to crystalloid or blood cardioplegic solutions inducing depolarized arrest. Ongoing patient demographic changes with increasingly older, comorbidly ill patients and increasing case complexity with increasingly structurally abnormal hearts as morphological correlate paired with evolutions in pediatric cardiac surgery allowing more complex procedures than ever before redefine requirements for cardioprotection. Many, in part adversarial, regimens to protect the myocardium from ischemic insults have entered clinical routine; however, functional recovery of the heart is still often impaired due to perfusion injury. Myocardial reperfusion damage is a key determinant of postoperative organ functional recovery, morbidity, and mortality in adult and pediatric patients. There is a discrepancy between what current protective strategies are capable of and what they are expected to do in a rapidly changing cardiac surgery community. An increased understanding of the molecular players of ischemia reperfusion injury offers potential seeds for new cardioprotective regimens and may further displace boundaries of what is technically feasible.
authors.affiliation: Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Andreas
authors.identifier: 0000-0003-3946-418X
authors.initials: A
authors.lastname: Habertheuer
authors.affiliation: Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Alfred
authors.identifier: 0000-0002-2818-2227
authors.initials: A
authors.lastname: Kocher
authors.affiliation: Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Günther
authors.initials: G
authors.lastname: Laufer
authors.affiliation: Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Martin
authors.identifier: 0000-0003-3142-5717
authors.initials: M
authors.lastname: Andreas
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.affiliation: Department of Dermatology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Petzelbauer
authors.affiliation: Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Marek
authors.initials: M
authors.lastname: Ehrlich
authors.affiliation: Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Dominik
authors.identifier: 0000-0002-2055-8293
authors.initials: D
authors.lastname: Wiedemann
mesh_terms: D000818:Animals; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D055724:Electrophysiological Phenomena; D006323:Heart Arrest / Q000503:physiopathology; D006801:Humans; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000503:physiopathology; D010818:Practice Patterns, Physicians'; D057170:Translational Research, Biomedical
chemical_list: D002316:Cardiotonic Agents