title: Remote ischaemic preconditioning as a method for perioperative cardioprotection: concepts, applications and future directions.
abstract: Remote ischaemic preconditioning (RIPC) is a phenomenon whereby brief episodes of non-lethal ischaemia in one organ or tissue can render a distant organ or tissue resistant to subsequent longer ischaemic insults. It represents an exciting perioperative risk reduction strategy as it allows cardioprotection (and organ protection in general) from injuries that are caused by multiple mechanisms. Several proof of concept studies show benefits in cardiovascular interventions and in a variety of other procedures. However convincing and consistent evidence of benefits in patient important outcomes is lacking but may emerge with the completion of large scale studies. This article aims to provide a concise review of the origins and concepts of RIPC. It will revisit the biological theories of RIPC and the clinical applications thus far. The article concludes by discussing the current status of multi-centre cardiovascular RIPC research and the future challenges that investigators must overcome.
authors.affiliation: Department of Surgery, University of Limerick, Ireland. Electronic address: donagh1@hotmail.com.
authors.forename: Donagh A
authors.initials: DA
authors.lastname: Healy
authors.affiliation: Department of Surgery, University of Limerick, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Clarke Moloney
authors.affiliation: Department of Surgery, University of Limerick, Ireland.
authors.forename: Seamus M
authors.initials: SM
authors.lastname: McHugh
authors.affiliation: Department of Surgery, University of Limerick, Ireland.
authors.forename: Pierce A
authors.initials: PA
authors.lastname: Grace
authors.affiliation: Department of Surgery, University of Limerick, Ireland.
authors.forename: Stewart R
authors.initials: SR
authors.lastname: Walsh
mesh_terms: D000818:Animals; D013504:Cardiovascular Surgical Procedures; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D017202:Myocardial Ischemia / Q000517:prevention & control*; D011300:Preoperative Care; D015427:Reperfusion Injury / Q000517:prevention & control; D014656:Vascular Surgical Procedures
keywords: Cardiac surgery; Cardioprotection; Ischaemic preconditioning; Percutaneous coronary intervention; Remote ischaemic preconditioning