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BioMed Research International
Volume 2014 (2014), Article ID 325725, 11 pages
http://dx.doi.org/10.1155/2014/325725
Review Article

Cardioprotection: A Review of Current Practice in Global Ischemia and Future Translational Perspective

1Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
2Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA
3Department of Dermatology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria

Received 19 June 2014; Revised 31 July 2014; Accepted 11 August 2014; Published 8 September 2014

Academic Editor: M.-Saadeh Suleiman

Copyright © 2014 Andreas Habertheuer et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.