Protection in the failing heart

Myocardial protection for surgical procedures on the failing heart can be broken down into three areas. The first area involves selection of the appropriate patient with enough myocardial viability and contractile reserve to permit a substantial cross-clamp time. Secondly, there should be adequate targets to revascularize or adequate tissue for reparative surgery. Thirdly, and most importantly, antegrade and retrograde blood cardioplegia given in sufficient amounts to satisfy myocardial oxygen needs is of prime importance.