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Since its introduction into clinical practice by Bigelow et al. at the University of Toronto over 40 years ago, hypothermia (the cooling of the myocardium) has remained the gold standard for intraoperative myocardial protection. The goal of this technique is to decrease myocardial metabolism during the ischemic period once the aorta is cross-clamped and blood flow to the heart is terminated.

Cardioplegia, the elective arrest of cardiac activity, is necessary during heart surgery to ensure a quiet surgical field. Recently, cardiac surgeons have used normothermic (37oC) blood cardioplegia as their method of myocardial protection, based on principles developed by Salerno et al. at McGill University and later continued at the University of Toronto. The aim of these normothermic techniques is to minimize myocardial ischemia bycontinuously supplying oxygen and warm blood to the arrested heart. This allows aerobic resuscitation of injured myocardium. Moreover, normothermic blood cardioplegia avoids many of the adverse effects caused by hypothermia, such as the depletion of high-energy phosphates and delays in the recovery of metabolism and function following reperfusion.