Milestones in the development of cardioplegia.

Long before there was a possibility for the application of cardioplegia to clinical situations, physiologists and surgeons studied the influence of various cations on function of the myocardial cell. These monumental studies helped set the stage for the eventual practical application of various means of myocardial preservation once open cardiac surgical techniques became available. This presentation attempts to summarize early research effort from the work of Sidney Ringer in 1878 until the present time. The historical progression of myocardial protective strategies is reviewed in a sequential fashion, highlighting major contributions and practices of investigators at the time. It is hoped that such a review of the accomplishments of our colleagues past and present will improve our perspective regarding current applications of such knowledge and that it may stimulate further inquiry toward improving present-day myocardial preservation strategies.