Myocardial Protection and Cardioplegia: Advances in Intraoperative Cardiac Preservation

Optimal myocardial protection during cardiac surgery remains a cornerstone of operative success and a subject of ongoing scientific inquiry. This chapter reviews the evolution of cardioplegia solutions and delivery strategies, comparing crystalloid and blood cardioplegia formulations, antegrade and retrograde delivery routes, and continuous versus intermittent arrest techniques in the context of modern evidence. Recent advances — including histidine-tryptophan-ketoglutarate (HTK) solutions, del Nido cardioplegia, and miniaturized perfusion systems — are critically evaluated alongside emerging investigational strategies involving mitochondrial-targeted agents and metabolic conditioning approaches to ischemia-reperfusion injury.