Cardioplegia solutions commonly used in cardiac surgery, without doubt, have decreased the damage to the myocardium during these procedures; nonetheless, optimal cardioplegia composition is still under investigation, one of the most important factors to date is the use of hypothermia. Intermittent cold cardioplegia has been adopted as the choice for myocardial protection by surgeons. An alternative method, based on the principles of electromechanic asystole and normothermic aerobic perfusion, is the use of blood cardioplegia. As Follete et al. demonstrated, blood cardioplegia protects more than asanguineous cardioplegia, this conclusion is based on abnormal electrocardiographic tracings and enzyme activity in the postoperative period when both methods are compared. In this review we make a brief introduction on the physiologic and ischemic conditions of the myocardial cell, as well as on the principles of myocardial protection and techniques designed to avoid ischemic damage.