Pediatric myocardial protection

Purpose of review Myocardial protection has contributed greatly to significant advances in pediatric cardiac surgery. New refinements in perfusion techniques and cardioplegia are under evaluation. Genetic factors are also promising tools to assess and improve myocardial protection. Recent findings There is increasing doubt about the efficiency of hypothermia in preventing postoperative complications. Pediatric perfusion is progressively moving towards warm perfusion, and avoiding the negative side effects of hypothermia. There is also a large body of evidence of blood cardioplegia superiority over crystalloid cardioplegia. Heat shock protein upregulation could be a relevant factor in the improvement of myocardial protection. The efficiency and safety of intermittent warm blood cardioplegia have been demonstrated in Europe in large studies. Validation of the benefit of small bypass circuit and blood-free surgery is in progress. Summary Cardioplegia is the most important factor in myocardial protection, but all the facets of the procedure must be concerned with the protection of the heart. There is emerging evidence that warm surgery with low prime bypass and intermittent warm blood cardioplegia is a valid alternative to hypothermic perfusion with cold cardioplegia using a larger priming volume.