Abstract
Off-pump coronary artery bypass surgery by avoiding cardioplegic arrest seems to reduce the risk of ischemic myocardial injury. However, even short-term regional ischemic periods, hemodynamic instability and arrhythmias associated with the procedure can be responsible for myocardial damage. Conditioning, a potential cardio-protective tool during on-pump cardiac surgery, has hardly been investigated in the context of off-pump surgery. There are virtually no large trials on remote ischemic preconditioning and the majority of reports have focused on central ischemic conditioning. Similarly, volatile anesthetic agents with conditioning effect like ischemic preconditioning have been shown to reduce cardiac injury during on-pump procedures but have not been validated in the off-pump scenario. Here, we review the available evidence on myocardial conditioning, either with ischemia/reperfusion or volatile anesthetic agents in patients undergoing off-pump coronary artery surgery.
Highlights
Off-pump coronary artery bypass surgery by avoiding cardioplegic arrest seems to reduce the risk of ischemic myocardial injury
Wu et al [22] reported that ischemic preconditioning (IP), induced by to cycles of 2 minutes occlusion of Left anterior descending artery (LAD) followed by reperfusion, led to a positive suppression of HR and reduced the incidence of supra-ventricular and ventricular arrhythmias, the incidence of post-operative atrial fibrillation (AF) remained similar between preconditioned and non-preconditioned groups
Off-pump CABG (OPCAB) is thought to reduce the extent of general ischemia, ischemic cardiac insult can be found in up to 10% of the patients [12]
Summary
Lower limb 4 cycles of 5 min ischemia and 5 min of reperfusion before anastomoses (RIPC) and after anastomoses (RIPostC). Hong et al (2010)] Anaesth Intensive Care, Korea [19] Prospective randomized controlled trial. Succi et al (2010) Arq Bras Cardiol, Brasil [20] Prospective controlled randomized trial. IP induced with twice 1 min LAD occlusion followed 2 min reperfusion before the anastomosis. Drenger et al (2008) Journal of Cardiothoracic and Vascular Anesthesia, Israel [21] Prospective controlled randomized trial. Wu et al (2003) Journal of Cardiothoracic and Vascular Anesthesia, Finland [22] Prospective controlled randomized trial. IP induced with single 5 min LAD occlusion followed by 5 min reperfusion 1.6% ENF started 15 min before LAD occlusion
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