In this issue, De Vecchi and colleagues report an association between preoperative ventricular function and the degree of myocardial oxidative stress occurring during coronary artery bypass surgery.1 They found a relation between left ventricular ejection fraction and myocardial glutathione concentrations and suggest that hearts with the poorest function have the weakest defences against oxidative stresses induced by ischaemia and reperfusion. The study has explored the subject from a novel viewpoint and if the findings are substantiated they have implications for myocardial protection in clinical practice.

Since the early 1980s it has been accepted that oxygen derived free radicals are involved in myocardial injury following ischaemia and reperfusion; therefore, free radicals have been of great interest to cardiac surgeons.2 A free radical is simply a molecule with an unpaired electron that makes it highly reactive and potentially damaging to lipid cell membranes and proteins. Free radicals are produced during normal physiological conditions but are inactivated by intracellular enzymatic scavengers—for …