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Conceptually, it is still unclear by how much the time window for successful reperfusion is extended by preconditioning, and how long the duration of ischemia can be so that adjunct cardioprotection by postconditioning at reperfusion still protects. Experimental studies addressing long-term effects of adjunct cardioprotection beyond infarct size reduction, that is, on repair, remodeling, and mortality, are lacking. Technically, reproducibility and robustness of experimental studies are often limited. Grave faults in design and conduct of clinical trials have also substantially contributed to the failure of translation of cardioprotection to clinical practice. Cardiovascular surgery with ischemic cardioplegic arrest is only a surrogate of acute myocardial infarction and confounded by the choice of anesthesia, hypothermia, cardioplegia, and traumatic myocardial injury. Trials in patients with acute myocardial infarction have been performed on agents\/interventions with no or inconsistent previous animal data and in patients who had either some reperfusion already at admission or were reperfused too late to expect any myocardial salvage. Of greatest concern is the lack of adequate phase II dosing and timing studies when rushing from promising proof-of-concept trials with surrogate end points such as infarct size to larger clinical outcome trials. Future trials must focus on interventions\/agents with robust preclinical evidence, have solid phase II dosing and timing data, and recruit patients who have truly a chance to benefit from adjunct cardioprotection.<\/jats:p>","DOI":"10.1161\/circresaha.117.310820","type":"journal-article","created":{"date-parts":[[2017,4,27]],"date-time":"2017-04-27T16:00:37Z","timestamp":1493308837000},"page":"1477-1486","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":287,"title":["Critical Issues for the Translation of Cardioprotection"],"prefix":"10.1161","volume":"120","author":[{"given":"Gerd","family":"Heusch","sequence":"first","affiliation":[{"name":"From the Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvq129"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.032698"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60916-7"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.113.300764"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvu225"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.022829"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw145"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.308736"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.02.032"},{"key":"e_1_3_4_11_2","first-page":"774","article-title":"The pathophysiology of acute myocardial infarction and strategies of protection beyond reperfusion: a continual challenge.","volume":"38","author":"Heusch G","year":"2016","unstructured":"Heusch G, Gersh BJ. 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