Avoiding unnecessary myocardial damage has been at the forefront of cardiac surgery since its early days. The ability to arrest and immobilize the heart and revive it again without loss of function has facilitated more and more complex surgeries. Effective myocardial protection, particularly for the duration of aortic cross clamping, involves multimodal strategies consisting of temperature management, cardioplegic solutions delivered by various routes as well as non-cardioplegic techniques like ischemic preconditioning through intermittent cross-clamping or pharmacological protection.