Myocardial protection and conditioning

Background. Myocardial tissue necrosis following transient ischemia is aggravated by subsequent reperfusion injury. Cardioprotective agents are sought which can reduce the extent of ischemic damage and ideally prevent the development of reperfusion injury entirely. Aim. This article summarizes the results of current research on this topic. Material and methods. A review is presented based on a selective search of the literature. Results. There is currently no clinically implemented technique for protection that fulfils these idealized criteria so that the search for protective substances will be continued. Conclusion. Especially myocardial conditioning prior to or after ischemic injury can be achieved by various stimuli. Preconditioning, e.g. by volatile anesthetic agents, was successful, demonstrating two protective time windows in animal experiments; however, translation from bench to bedside has failed due to a multitude of reasons. Adverse remodelling is another target of myocardial conditioning: as a result of myocardial tissue necrosis a ventricular maladaptation ensues that finally leads to a self-sustaining pathological process. As long as the translation of promising substances into clinical implementation is unsuccessful, protection of high-risk patients can only be achieved by conventional approaches (e.g. hypothermia and cardioplegia) or risk reduction by selection of conservative minimally invasive operative procedures.