title: [Cardioprotection in cardiac surgical patients : Everything good comes from the heart].
abstract: BACKGROUND
  Despite substantial success in the anesthetic and surgical management of cardiac surgery, patients frequently show postoperative complications and organ dysfunctions. This is highly relevant for mid- to long-term outcomes.
  
  
  OBJECTIVE
  To evaluate cardioprotective strategies that may offer effective protection in vulnerable cardiac surgery patients.
  
  
  METHODS
  To demonstrate recent cardioprotective approaches for cardiac surgery patients, aiming to modulate the body's own protective mechanisms in cardiac surgery patients.
  
  
  RESULTS
  Both cardioplegia and hypothermia belong to the well-established protective strategies during myocardial ischemia. Volatile anesthetics have been repeatedly shown to improve the left ventricular function and reduce the extent of myocardial injury compared to a control group with intravenous anesthesia. Furthermore, patients receiving volatile anesthetics showed a significantly shortened stay in the ICU and in hospital after cardiac surgery. In contrast, numerous other protective strategies failed translation into the clinical practice. Despite the published reduction of troponin release after remote ischemic preconditioning, two recent large-scale randomized multicenter trials were unable to demonstrate a clinical benefit.
  
  
  CONCLUSIONS
  Beside the use of cardioplegia and hypothermia, the use of volatile anesthetics is well-established during cardiac surgery because of its conditioning and protective properties. Regardless of the promising results derived from experimental studies and small clinical trials, the majority of other approaches failed to translate their findings into the clinic. Therefore, systematic experimental studies are needed to identify potential confounding factors that may affect the protective effects.
authors.affiliation: Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland. christian.stoppe@gmail.com.|Institut für Biochemie und Molekulare Zellbiologie, RWTH Aachen, Aachen, Deutschland. christian.stoppe@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Stoppe
authors.affiliation: Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt/Main, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Meybohm
authors.affiliation: Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Coburn
authors.affiliation: Klinik für Thorax-, Herz- und Gefäßchirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Goetzenich
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D006321:Heart / Q000503:physiopathology*; D006331:Heart Diseases / Q000517:prevention & control*; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D011183:Postoperative Complications / Q000517:prevention & control*
keywords: Cardiac surgery; Cardioprotection; Conditioning; Inflammation; Ischemia-reperfusion; Organ injury