title: Remote ischemic preconditioning reduces myocardial injury after coronary artery bypass surgery with crystalloid cardioplegic arrest.
abstract: 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 < 0.0001) in the RIPC patients (N = 27) than in controls (N = 26), resulting in a 44.5% reduction of cTnI (AUC at 72 h). RIPC by repetitive inflation of a cuff around the left upper arm before surgery enhances myocardial protection in patients undergoing CABG surgery with antegrade cold crystalloid cardioplegia.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Germany. matthias.thielmann@uni-due.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.forename: Eva
authors.initials: E
authors.lastname: Kottenberg
authors.forename: Kerstin
authors.initials: K
authors.lastname: Boengler
authors.forename: Christoph
authors.initials: C
authors.lastname: Raffelsieper
authors.forename: Markus
authors.initials: M
authors.lastname: Neuhaeuser
authors.forename: Jürgen
authors.initials: J
authors.lastname: Peters
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.forename: Gerd
authors.initials: G
authors.lastname: Heusch
mesh_terms: D000368:Aged; D001132:Arm / Q000098:blood supply*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D007668:Kidney / Q000098:blood supply / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000473:pathology / Q000517:prevention & control*; D009206:Myocardium / Q000473:pathology; D011183:Postoperative Complications / Q000473:pathology / Q000517:prevention & control; D017680:Potassium Compounds / Q000627:therapeutic use*; D014111:Tourniquets
chemical_list: D002316:Cardiotonic Agents; D017680:Potassium Compounds; C018369:potassium cardioplegic solution