This international, multicenter randomized controlled trial involved 1,039 adult patients. It compared outcomes in scheduled or urgent cardiac procedures—coronary artery bypass grafting (CABG), aortic valve replacement (AVR), or a combination of both—using either conventional extracorporeal circulation (CECC) or minimally invasive extracorporeal circulation (MiECC).

This literature review revisits the pathophysiological principles of ischemia, reperfusion, and myocardial ischemia tolerance, as well as the concepts of myocardial protectioN and the main evidence on outcomes among different cardioplegia solutions retrospectively since 2020.

Comparison between two perfusion strategies during cardiopulmonary bypass: one guided by an oxygen delivery index (DO2i >300 mL/min/m²) based on body surface area and another conventional strategy based solely on pump flow according to the patient’s body surface area (2.6 L/min/m²).