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Remote ischemic preconditioning reduces myocardial injury after coronary artery bypass surgery with crystalloid cardioplegic arrest

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Abstract

Remote ischemic preconditioning (RIPC) with transient upper limb ischemia reduces myocardial injury in patients undergoing on-pump coronary artery bypass grafting (CABG) with cross-clamp fibrillation or blood cardioplegia for myocardial protection. Whether or not such protection is still operative when standard crystalloid cardioplegic arrest is used is uncertain. Fifty-three consecutive, non-diabetic patients with triple-vessel disease and 64 ± 12 years of age (mean ± SD), who underwent elective CABG surgery with crystalloid (Bretschneider) cardioplegic arrest, were allocated in a prospective, randomized, single-blinded protocol to receive either a RIPC protocol (3 cycles of 5 min transient left upper arm ischemia induced by inflating a blood pressure cuff to 200 mmHg with 5 min of reperfusion) or control, respectively, after induction of anesthesia. Cardiac troponin I (cTnI) concentration was measured preoperatively and over 72 h postoperatively, and the area under the curve (AUC) was calculated. Peak postoperative cTnI concentration was significantly reduced from 13.7 ± 7.7 ng/mL in controls to 8.9 ± 4.4 ng/mL in RIPC (P = 0.008). Mean cTnI concentration was significantly lower at 6, 12, 24, and 48 h after surgery (ANOVA; P < 0.0001) in the RIPC patients (N = 27) than in controls (N = 26), resulting in a 44.5% reduction of cTnI (AUC at 72 h). RIPC by repetitive inflation of a cuff around the left upper arm before surgery enhances myocardial protection in patients undergoing CABG surgery with antegrade cold crystalloid cardioplegia.

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany

    Matthias Thielmann, Christoph Raffelsieper & Heinz Jakob

  2. Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany

    Eva Kottenberg & Jürgen Peters

  3. Institute for Pathophysiology, Center of Internal Medicine, University Hospital Essen, Essen, Germany

    Kerstin Boengler & Gerd Heusch

  4. Department of Mathematics and Technology, Koblenz University of Applied Science, Remagen, Germany

    Markus Neuhaeuser

  5. Institute of Medical Informatics, Biometry, and Epidemiology, University Hospital Essen, Essen, Germany

    Markus Neuhaeuser

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  1. Matthias Thielmann
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  2. Eva Kottenberg
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Correspondence to Matthias Thielmann.

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D. M. Yellon, London, UK served as guest editor for the manuscript and was responsible for all editorial decisions, including the selection of reviewers. The policy applies to all manuscripts with authors from the editor's institution.

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Thielmann, M., Kottenberg, E., Boengler, K. et al. Remote ischemic preconditioning reduces myocardial injury after coronary artery bypass surgery with crystalloid cardioplegic arrest. Basic Res Cardiol 105, 657–664 (2010). https://doi.org/10.1007/s00395-010-0104-5

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  • DOI: https://doi.org/10.1007/s00395-010-0104-5

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