Physiological and cellular mechanisms of myocardial protection

BACKGROUND: Despite 40 years of clinically successful open heart surgery, cardiac surgeons continue to seek the ideal myoprotective strategy to minimize perioperative myocardial damage and maximize clinical outcome. Although crude measures, such as length of hospital stay or operative mortality rate, may provide useful administrative data, the ultimate outcome measure of significance to the patient is the lack of operatively induced myocellular injury. METHODS: An ideal biological marker would thus quantitate the number of viable and functioning myocytes remaining postoperatively. The purpose of the present review was to develop the theoretical framework for modern approaches to intraoperative myocardial protection when considering the fundamental principles of physiological and cellular ischemic mechanisms. RESULTS AND CONCLUSIONS: If is hoped that this review provides insight into the implementation of these fundamental concepts developed at the University of Illinois and applied in our present experiences in advanced myocardial muscle mechanics and molecular biology.