Remote ischemic preconditioning reduces myocardial injury after coronary artery bypass surgery with crystalloid cardioplegic arrest

Remote ischemic preconditioning (RIPC) with transient upper limb ischemia reduces myocardial injury in patients undergoing on-pump coronary artery bypass grafting (CABG) with cross-clamp fibrillation or blood cardioplegia for myocardial protection. Whether or not such protection is still operative w...

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Bibliographic Details
Published in:Basic research in cardiology 2010-09, Vol.105 (5), p.657-664
Main Authors: Thielmann, Matthias, Kottenberg, Eva, Boengler, Kerstin, Raffelsieper, Christoph, Neuhaeuser, Markus, Peters, Jürgen, Jakob, Heinz, Heusch, Gerd
Format: Article
Language:English
Subjects:
Aged
Arm - blood supply
Cardiology
Cardiotonic Agents - therapeutic use
Combined Modality Therapy
Coronary Artery Bypass - methods
Coronary Artery Disease - surgery
Female
Heart Arrest, Induced - methods
Humans
Ischemic Preconditioning, Myocardial - methods
Kidney - blood supply
Kidney - pathology
Male
Medicine
Medicine & Public Health
Middle Aged
Myocardial Reperfusion Injury - pathology
Myocardial Reperfusion Injury - prevention & control
Myocardium - pathology
Original Contribution
Postoperative Complications - pathology
Postoperative Complications - prevention & control
Potassium Compounds - therapeutic use
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Summary:Remote ischemic preconditioning (RIPC) with transient upper limb ischemia reduces myocardial injury in patients undergoing on-pump coronary artery bypass grafting (CABG) with cross-clamp fibrillation or blood cardioplegia for myocardial protection. Whether or not such protection is still operative when standard crystalloid cardioplegic arrest is used is uncertain. Fifty-three consecutive, non-diabetic patients with triple-vessel disease and 64 ± 12 years of age (mean ± SD), who underwent elective CABG surgery with crystalloid (Bretschneider) cardioplegic arrest, were allocated in a prospective, randomized, single-blinded protocol to receive either a RIPC protocol (3 cycles of 5 min transient left upper arm ischemia induced by inflating a blood pressure cuff to 200 mmHg with 5 min of reperfusion) or control, respectively, after induction of anesthesia. Cardiac troponin I (cTnI) concentration was measured preoperatively and over 72 h postoperatively, and the area under the curve (AUC) was calculated. Peak postoperative cTnI concentration was significantly reduced from 13.7 ± 7.7 ng/mL in controls to 8.9 ± 4.4 ng/mL in RIPC ( P  = 0.008). Mean cTnI concentration was significantly lower at 6, 12, 24, and 48 h after surgery (ANOVA; P  
ISSN:0300-8428
1435-1803
DOI:10.1007/s00395-010-0104-5