A comparison between ischemic preconditioning, intermittent cross-clamp fibrillation and cold crystalloid cardioplegia for myocardial protection during coronary artery bypass graft surgery.
The aim of this study was to compare ischemic preconditioning (IPC) with two established methods of myocardial protection, namely cold crystalloid cardioplegia and intermittent cross-clamp fibrillation (ICCF), in coronary artery bypass graft (CABG) surgery. This was a prospective randomised study. Thirty CABG patients were randomised to receive: (a) St Thomas' cardioplegia solution no. 2; (b) ICCF; or (c) IPC (two 3-min periods of ischemia with 2-min of reperfusion). Surgery was performed under standardised conditions by one surgeon (WBP). The primary endpoint was cardiac troponin T release during the first 72 h after surgery. Mean troponin T at 72 h was significantly lower in the IPC group (0.5 microg/l; p=0.05, ANOVA) compared with the cardioplegia and ICCF groups (2.1 and 1.3 microg/l respectively). This suggests that ischemic preconditioning is superior at limiting myocardial necrosis during CABG, but there is no difference between cold crystalloid cardioplegia and intermittent cross-clamp fibrillation.
Teoh
L K K
LK
The Hatter Institute for Cardiovascular Studies, UCL, Grafton Way, WC1E 6DB, London, UK.
Grant
R
R
Hulf
J A
JA
Pugsley
W B
WB
Yellon
D M
DM
D001013:Aorta, Thoracic; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000503:physiopathology; D002314:Cardioplegic Solutions / Q000008:administration & dosage; D003250:Constriction; D001026:Coronary Artery Bypass / Q000379:methods*; D004562:Electrocardiography; D006324:Heart Arrest, Induced / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D014693:Ventricular Fibrillation
D002314:Cardioplegic Solutions; D020107:Troponin T