Since the invention of cardiopulmonary bypass, cardioprotective strategies have been investigated to mitigate ischemic injury to the heart during aortic cross-clamping and reperfusion injury with cross-clamp release. With advances in cardiac surgical and percutaneous techniques and post-operative management strategies including mechanical circulatory support, cardiac surgeons are able to operate on more complex patients. Therefore, there is a growing need for improved cardioprotective strategies to optimize outcomes in these patients. This review provides an overview of the basic principles of cardioprotection in the setting of cardiac surgery, including mechanisms of cardiac injury in the context of cardiopulmonary bypass, followed by a discussion of the specific approaches to optimizing cardioprotection in cardiac surgery, including refinements in cardiopulmonary bypass and cardioplegia, ischemic conditioning, use of specific anesthetic and pharmaceutical agents, and novel mechanical circulatory support technologies. Finally, translational strategies that investigate cardioprotection in the setting of cardiac surgery will be reviewed, with a focus on promising research in the areas of cell-based and gene therapy. Advances in this area will help cardiologists and cardiac surgeons mitigate myocardial ischemic injury, improve functional post-operative recovery, and optimize clinical outcomes in patients undergoing cardiac surgery.

自体外循环发明以来，已经研究了心脏保护策略，以减轻主动脉夹闭期间对心脏的缺血性损伤和夹钳夹释放术的再灌注损伤。随着心脏外科和经皮技术以及包括机械循环支持在内的术后管理策略的进步，心脏外科医生能够对更复杂的患者进行手术。因此，越来越需要改进的心脏保护策略来优化这些患者的预后。本综述概述了心脏手术中心脏保护的基本原则，包括体外循环背景下的心脏损伤机制，然后讨论了优化心脏手术中心脏保护的具体方法，包括体外循环和心脏停搏的改进、缺血性调节、特定麻醉剂和药物的使用、 以及新型机械循环支持技术。最后，将回顾在心脏手术中研究心脏保护的转化策略，重点是基于细胞和基因治疗领域的有前途的研究。该领域的进展将帮助心脏病专家和心脏外科医生减轻心肌缺血性损伤，改善术后功能恢复，并优化接受心脏手术的患者的临床结果。