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

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

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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