The use of controlled reperfusion strategies in cardiac surgery to minimize ischaemia/reperfusion damage.

Ischaemia and reperfusion occur during almost every cardiac operation, and one of the key elements to achieve a successful operation is to counteract the detrimental effects of induced ischaemia and reperfusion during the operation. The cardiac surgeon is in a unique position to protect the heart before ischaemia is induced and to avoid further damage during the reperfusion period. The surgeon can alter the composition of the reperfusate and the conditions of reperfusion so that the ischaemia/reperfusion injury is minimal, even after very complex procedures that require long aortic cross-clamp periods. This in turn allows him to perform a near-perfect surgical repair of the underlying disease without the pressure of time. The vast knowledge gained in this field over the years has led to application in other organs, such as the limbs (acute limb ischaemia), lungs (lung transplantation), kidney and liver (kidney and liver transplantation), and more recently even for the brain [acute cerebral artery occlusion (stroke)] and the whole body (cardiopulmonary resuscitation). Further improvements in reperfusion strategies will allow salvage of tissue and even whole body after ischaemic periods thought previously to be irreversibly damaged.