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document
Regional ischemic preconditioning enhances myocardial performance in off-pump coronary artery bypass grafting . OBJECTIVES We intended to investigate whether ischemic preconditioning ( IP ) enhances myocardial performance in patients who undergo off-pump coronary artery bypass grafting ( CABG ) . DESIGN A controlled , randomized , prospective study . SETTING A university hospital . PATIENTS Thirty-two patients with left anterior descending coronary artery ( LAD ) or two-vessel heart disease ( including LAD ) who were to undergo off-pump CABG were randomized into an IP group and a control group . INTERVENTIONS IP was induced by occluding the LAD twice for a 2-min period followed by 3-min LAD reperfusion before bypass grafting of the first coronary vessel . MEASUREMENTS AND RESULTS Registration included hemodynamic data from the peripheral artery and the pulmonary artery , and the measurement of cardiac troponin I ( CTnI ) and creatine kinase isoenzyme MB ( CK-MB ) values . IP resulted in a complete recovery of the mean stroke volume index ( SVI ) after the operation . In the control subjects , the mean SVI showed a significant reduction postoperatively ( p = 0.039 ) . On the first postoperative day , the increase in the mean heart rate ( HR ) was also significantly lower in the IP patients . The CTnI level was statistically significantly lower in the IP group ( p = 0.043 ) , and IP patients tended to have a smaller CK-MB release after surgery ( not significant ) . The duration of mechanical ventilation , the length of stay in the ICU , and the use of inotropic medication did not increase after the IP protocol . CONCLUSIONS Two cycles of regional 2-min IP in the LAD , followed by 3 min of reperfusion , proved to be applicable and safe in patients undergoing off-pump myocardial revascularization , it tended to decrease the immediate myocardial enzyme release , it prohibited the postoperative increase in HR , and it enhanced the recovery of SVI .
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Intervention_Physical
Regional ischemic preconditioning
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Intervention_Physical
occluding the LAD twice for a 2-min period followed by 3-min LAD reperfusion before bypass grafting of the first coronary vessel .
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Outcome_Physical
myocardial
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Outcome_Physical
myocardial
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Outcome_Physical
cardiac troponin I ( CTnI )
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Outcome_Physical
creatine kinase isoenzyme MB ( CK-MB ) values
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Outcome_Other
recovery of the mean stroke volume index ( SVI )
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Outcome_Other
mean SVI
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Outcome_Physical
mean heart rate ( HR )
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Outcome_Physical
CTnI level
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Outcome_Physical
CK-MB release
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Outcome_Other
duration of mechanical ventilation , the length of stay
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Outcome_Other
use of inotropic medication
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Outcome_Physical
myocardial enzyme
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Outcome_Physical
HR
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Outcome_Physical
SVI