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Myocardial protection is essential in heart transplantation. With the rising number of patients on the waiting list, there has been a spike in marginal organ utilisation. Despite advances in healthcare, ongoing perfection of surgical technique and better understanding and usage of mechanical circulatory support, there is still a significant number of patients who develop Primary Graft Dysfunction. We look into the current literature to find essential pearls from the past with incremental games that can be employed to improve myocardial protection.