Myocardial protection during cardiac surgery - a history and review of cardioplegic solutions.

With the development of cardiac surgery, particularly after 1953, when open-heart operations were first performed, the issue of protecting the myocardium from ischemic injury during cardiac arrest emerged. The most widely adopted method of myocardial protection became the use of cardioplegia, although other techniques, such as hypothermia, were also explored. Over the years, various cardioplegic solutions and their modifications have been developed to ensure myocardial protection, and today a wide range of these solutions are used in clinical practice. In the Czech Republic, the most commonly applied cardioplegias include St. Thomas, del Nido, and histidine--tryptophan-ketoglutarate. Cardioplegia not only protects the myocardium but also enables controlled cardiac arrest and the creation of a bloodless surgical field. Each type of cardioplegia has its advantages and limitations, and the choice of a specific solution depends on the type and duration of the surgical procedure, as well as the preferences of the cardiac surgeon. The aim of this article is to provide an overview of current myocardial protection strategies, with a focus on their mechanisms of action, historical development, and clinical application in the Czech Republic.