ORIGINAL ARTICLES  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2002 June;43(3):319-26

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Ischemic preconditioning protects right ventricular function in coronary artery bypass grafting patients experiencing angina within 48-72 hours

Wu Z. K., Pehkonen E., Laurikka J., Kaukinen L., Honfonen E. L., Kaukinen S., Tarkka M. R.

From the Division of Cardiac Surgery *Department of Anesthesiology and Intensive Care Tampere University Hospital Tampere, Finland

Background. To ­test wheth­er ischem­ic pre­con­di­tion­ing (IP) is ­able to pro­tect the myo­car­di­um in recent­ly ­unstable ­CABG ­patients.
Methods. Experimental ­design: pros­pec­tive, ran­dom­ised, con­trolled clin­i­cal ­study. Setting: University Hospital. Patients: Forty ­CABG ­patients ­with ­recent ­unstable angi­na ­were ran­dom­ised ­into an IP ­group (n=20) and a con­trol ­group (n=20). Subgroup was devid­ed ­based on the ­time of the ­most ­recent ische­mia ­onset ­before the oper­a­tion. Intervention: The IP ­group was pre­con­di­tioned ­with 2 ­cycles of 2-min ische­mia fol­lowed by 3-min reper­fu­sion ­before ­cross clamp­ing. Measures: Hemodynamic ­data ­were mon­i­tored ­till the 1st POD. Biochemical mark­ers ­were meas­ured ­till the 2nd POD.
Results. There ­were no dif­fer­enc­es in car­diac ­index (Cl) and ­right ven­tric­u­lar ejec­tion frac­tion (­RVEF) in ­patients expe­ri­enc­ing angi­na with­in 48 ­hours ­prior to oper­a­tion. The per­cent­age chang­es in CI and ­RVEF at 1 ­hour ­after declamp­ing ­were sig­nif­i­cant­ly bet­ter in the IP ­group in ­patients expe­ri­enced angi­na with­in 48-72 ­hours (106% vs 88% of base­line, p=0.027 and 103% vs 81% of base­line, p=0.023). No dif­fer­ence in post­op­er­a­tive car­diac tro­po­nin I (CTnI) and CK-MB was ­found ­between the IP and con­trols in ­either sub­group.
Conclusions. IP has a ben­e­fi­cial ­effect on glo­bal and ­right ven­tric­u­lar hemo­dy­nam­ic func­tion­al recov­ery in ­unstable ­CABG ­patients expe­ri­enc­ing angi­na with­in 48-72 ­hours ­prior to the oper­a­tion. However, IP has no addi­tion­al pro­tec­tive ­effects in ­unstable ­CABG ­patients who expe­ri­ence angi­na with­in 48 ­hours.