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The Journal of Cardiovascular Surgery 1998 December;39(6):791-5

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Evaluation of perioperative myocardial tissue damage in ischemically preconditioned human heart during aorto coronary bypass surgery

Szmagala P., Morawski W., Krejca M., Gburek T., Bochenek A.

From the 1st Cardiac Surgery Department Silesian Heart Center, Katowice, Poland


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Back­ground. Pre­con­di­tioning myo­car­dium ­with ­short ­periods of ­ischaemic ­stress inter­spersed ­with reper­fu­sion ­increases its resis­tance to infarc­tion. ­Ischaemic pre­con­di­tioning pro­tec­tion ­occurred in ­human ­beings ­during ­unstable ­angina pre­ceding myo­car­dial infarc­tion, ­during per­cut­aneous trans­lu­minal cor­o­nary angio­plasty and ­during ­aorto cor­o­nary ­bypass sur­gery. The pur­pose of ­this ­study was to ­test (util­ised car­diac tro­ponin T meas­ure­ment) ­whether ­ischaemic pre­con­di­tioning was ­able to pro­tect myo­car­dial ­tissue ­during the per­i­op­er­a­tive ­period and how ­long ­that pro­tec­tion ­lasted.
­Methods. ­Patients ­were ­recruited to the pre­con­di­tioned ­group (n=29), ­received 4-min of ­aortic ­cross- ­clamping and 6 min reper­fu­sion ­prior to ­CABG per­formed ­with inter­mit­tent ­ischaemic ­arrest and the con­trol ­group (n=27) ­received ­only an ­ischaemic ­insult of oper­ating pro­ce­dure. TnT meas­ure­ments ­were deter­mined ­from ­blood sam­ples ­taken ­before sur­gery (A), 1 ­hour ­after ­onset of CPB (B), 4 ­hours (C), 8 ­hours (D), 12 ­hours (E), 24 ­hours (F), 48 ­hours (G) and 72 ­hours ­after CPB (H).
­Results. ­Results ­were ­expressed as the ­median, ­range and stan­dard devi­a­tion (SD) of TnT con­cen­tra­tion (µg/l). ­Ischaemic pre­con­di­tioning ­decreased TnT con­cen­tra­tion ­with sta­tis­tical sig­nif­i­cance 1 ­hour ­after ­onset of CPB (pre­con­di­tioned B: ­median 0.12±0.25 vs con­trol B: ­median 0.32±0.43, p=0.03). ­There ­were not­able dif­fer­ences in TnT con­cen­tra­tion in C, D, E, F, G, H ­blood sam­ples ­between the con­trol and the pre­con­di­tioned ­group but ­with p ­value of no sta­tis­tical sig­nif­i­cance.
Con­clu­sions. ­These ­data illus­trate ­that ­ischaemic pre­con­di­tioning ­limits myo­car­dial ­damage ­during oper­a­tive pro­ce­dure and it may prob­ably ­afford pro­tec­tion ­during a post­op­er­a­tive ­period.

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