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Eur J Cardiothorac Surg 2003;24:986-993
© 2003 Elsevier Science NL

Review

Myocardial protection in adult cardiac surgery: current options and future challenges

^a Department of Cardiac Surgery, University of Parma, Parma, Italy
^b Department of Biochemistry ‘G. Moruzzi’, University of Bologna, Bologna, Italy

Received 24 December 2002; received in revised form 31 May 2003; accepted 23 July 2003.

^* Corresponding author. Cattedra e Divisione di Cardiochirurgia, Università degli Studi, Via A. Gramsci, 14, 43100 Parma, Italy. Tel.: +39-0521-290470; fax: +39-0521-293196
e-mail: francesconicolini{at}libero.it

Current techniques of myocardial protection are evolving with the use of less conventional modalities of cardioplegia and have reduced the morbidity and mortality of cardiac operations. Blood cardioplegic solutions appear superior to cold cardioplegia in terms of myocardial protection and adjuncts as glutamate/aspartate enhancement, antioxidant supplementation, nitric oxide donors and maintenance of calcium homeostasis seem effective. In the near future, further experimental and clinical investigations about pharmacological preconditioning, sodium–hydrogen exchangers inhibition and gene therapy need to be addressed to well define their potential role in the improvement of current techniques of myocardial protection that are suboptimal in high-risk clinical settings.

Key Words: Myocardial protection • Cardioplegia • Cardiac surgery

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