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Ann Thorac Surg 2000;70:1551-1557
© 2000 The Society of Thoracic Surgeons

Original articles: cardiovascular

Beneficial effects of ischemic preconditioning on right ventricular function after coronary artery bypass grafting

Zhong-Kai Wu, MDa, Matti R. Tarkka, MDa, Erkki Pehkonen, MDa, Liisa Kaukinen, MDb, Eva L. Honkonen, MDb, Seppo Kaukinen, MDb

a Division of Cardiac Surgery, Tampere University Hospital, Tampere, Finland
b Department of Anesthesiology and Intensive Care, Tampere University Hospital, Tampere, Finland

Address reprint requests to Dr Tarkka, Clinic of Cardiothoracic Surgery, Tampere University Hospital, 33521 Tampere, Finland
e-mail: matti.tarkka{at}tays.fi

Background. Preservation of right ventricular myocardium is unsatisfactory in patients with critical stenosis or occlusion of the right coronary artery. The aim of this study was to investigate whether ischemic preconditioning (IP) improved the recovery of right ventricular function after coronary artery bypass grafting.

Methods. Forty patients with three-vessel disease who had coronary artery bypass grafting were randomly assigned to the IP group (n = 20) or control group (n = 20). In the IP group, two cycles of two minutes of ischemia after three minutes of reperfusion were given before cross-clamping. Hemodynamic data were collected. Right ventricular ejection fraction was measured by thermodilution.

Results. Right ventricular ejection fraction and right ventricular systolic volume index were decreased postoperatively (lowest value at 6 hours postoperatively). The changes in right ventricular ejection fraction were significantly milder in the IP group postoperatively (p = 0.012). The decrease in right ventricular systolic volume index postoperatively was also less in IP patients (p = 0.002). Fewer inotropic drugs were used in the IP group compared with controls.

Conclusions. Ischemic preconditioning had a myocardial protective effect on recovery of right ventricular contractility in patients who had coronary artery bypass grafting.




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