title: Remote ischemic preconditioning:  the surgeon's perspective.
abstract: Since cardiac surgery began, surgeons have aimed to find methods of minimizing myocardial injury resulting from ischemia and reperfusion. The concept of somehow conditioning the heart in order to attenuate ischemia and reperfusion-related injury has evolved in cardiovascular research over decades, from ischemic preconditioning and postconditioning to, more recently, remote ischemic preconditioning (and postconditioning). Although many strategies have proven to be beneficial in the experimental arena, a few have been successfully translated into clinical practice. Remote ischemic preconditioning, with the use of brief episodes of ischemia and reperfusion of vascular territories remote from the heart, has been shown convincingly to decrease myocardial injury. To date, the translation of this powerful innate mechanism of myocardial and/or multiorgan protection from the animal lab to the operating theatre, using transient occlusion of blood flow to the upper limb with a blood-pressure cuff before cardiac surgery, has shown promising results, with several proof-of-principle and first randomized controlled clinical trials reporting benefits for patients undergoing cardiac surgery. If the efficacy of remote ischemic preconditioning can be conclusively proven, the clinical applications in cardiac surgery could be almost infinite, providing multiorgan protection in various surgical scenarios.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany. matthias.thielmann@uni-due.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendt
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsagakis
authors.forename: Vivien
authors.initials: V
authors.lastname: Price
authors.forename: Daniel-Sebastian
authors.initials: DS
authors.lastname: Dohle
authors.forename: Susanne
authors.initials: S
authors.lastname: Pasa
authors.forename: Eva
authors.initials: E
authors.lastname: Kottenberg
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*