title: Myocardial conditioning techniques in off-pump coronary artery bypass grafting.
abstract: Off-pump coronary artery bypass surgery by avoiding cardioplegic arrest seems to reduce the risk of ischemic myocardial injury. However, even short-term regional ischemic periods, hemodynamic instability and arrhythmias associated with the procedure can be responsible for myocardial damage. Conditioning, a potential cardio-protective tool during on-pump cardiac surgery, has hardly been investigated in the context of off-pump surgery. There are virtually no large trials on remote ischemic preconditioning and the majority of reports have focused on central ischemic conditioning. Similarly, volatile anesthetic agents with conditioning effect like ischemic preconditioning have been shown to reduce cardiac injury during on-pump procedures but have not been validated in the off-pump scenario. Here, we review the available evidence on myocardial conditioning, either with ischemia/reperfusion or volatile anesthetic agents in patients undergoing off-pump coronary artery surgery.
authors.affiliation: NHLI, Hammersmith Hospital, Imperial College London, London, UK. m.moscarelli@imperial.ac.uk.|Fondazione Monasterio, Ospedale Pasquinucci, Massa, Italy. m.moscarelli@imperial.ac.uk.
authors.forename: Marco
authors.initials: M
authors.lastname: Moscarelli
authors.affiliation: NHLI, Hammersmith Hospital, Imperial College London, London, UK. p.punjabi@imperial.ac.uk.
authors.forename: Prakash P
authors.initials: PP
authors.lastname: Punjabi
authors.affiliation: NHLI, Hammersmith Hospital, Imperial College London, London, UK. miroslav.gamov@imperial.nhs.uk.
authors.forename: Gamov I
authors.initials: GI
authors.lastname: Miroslav
authors.affiliation: Fondazione Monasterio, Ospedale Pasquinucci, Massa, Italy. paolo.delsarto@ftgm.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Sarto
authors.affiliation: NHLI, Hammersmith Hospital, Imperial College London, London, UK. f.fiorentino@imperial.ac.uk.
authors.forename: Francesca
authors.initials: F
authors.lastname: Fiorentino
authors.affiliation: NHLI, Hammersmith Hospital, Imperial College London, London, UK. g.d.angelini@imperial.ac.uk.|Bristol Heart Institute, University of Bristol, Bristol, UK. g.d.angelini@imperial.ac.uk.
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
mesh_terms: D000777:Anesthetics / Q000627:therapeutic use*; D009202:Cardiomyopathies / Q000517:prevention & control*; D047549:Coronary Artery Bypass, Off-Pump; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*
chemical_list: D000777:Anesthetics