Introduction (1)

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Although the efficacy in cardiothoracic-surgery has been well established, peri-operative mortality and morbidity remain significant, especially in patients with preexisting heart failure. Reduction of mortality and morbidity is essential to increase the safety of the procedures and to extend the indications to asymptomatic patients and high risk procedures. Common occurrence of systemic complications after cardiac surgery, such as vasodilatation and ventilatory problems, indicate the role of a systemic response to the impaired outcome. It is conceived that a vicious circle of 2 biological processes is responsible for initiating a systemic response related to the high impaired post-operative outcome: Myocardial Ischemia Reperfusion Injury (MIRI) and the Systemic Inflammatory Response Syndrome (SIRS).

MIRI is the paradoxical exacerbation of myocardial damage upon restoration of blood supply to previously ischemic myocardial tissue and is considered the major, inevitable, cause of tissue damage after ischemic events such as myocardial infarction and cardiac surgery. The pathophysiology of MIRI is complex and its exact mechanisms have not been fully elucidated yet.

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