title: A comparison between ischemic preconditioning, intermittent cross-clamp fibrillation and cold crystalloid cardioplegia for myocardial protection during coronary artery bypass graft surgery.
abstract: 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.
authors.affiliation: The Hatter Institute for Cardiovascular Studies, UCL, Grafton Way, WC1E 6DB, London, UK.
authors.forename: L K K
authors.initials: LK
authors.lastname: Teoh
authors.forename: R
authors.initials: R
authors.lastname: Grant
authors.forename: J A
authors.initials: JA
authors.lastname: Hulf
authors.forename: W B
authors.initials: WB
authors.lastname: Pugsley
authors.forename: D M
authors.initials: DM
authors.lastname: Yellon
mesh_terms: 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
chemical_list: D002314:Cardioplegic Solutions; D020107:Troponin T