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Ann Thorac Surg 2003;75:S709-S714
© 2003 The Society of Thoracic Surgeons

II: Surgical myocardial protection

Preconditioning and cardiac surgery

Jarle Vaage, MD, PhDa*, Guro Valen, MD, PhDb

a Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden,
b Crafoord Laboratory for Experimental Surgery, Karolinska Hospital, Stockholm, Sweden

* Address reprint requests to Dr Vaage, Department of Thoracic Surgery, Karolinska Hospital, 17176 Stockholm, Sweden.
e-mail: jarle.vaage{at}ks.se

Presented at the 3rd International Symposium on Myocardial Protection From Surgical Ischemic-Reperfusion Injury, Asheville, NC, June 2–6, 2002.

Abstract

Preconditioning is in experimental studies the most powerful mode of cardioprotection known. The signal transduction pathways involve a variety of trigger substances, mediators, receptors, and effectors. The studies of preconditioning in cardiac surgery provide conflicting results but the majority of studies show that ischemic preconditiong is an effective adjunct to myocardial protection. However, ischemic preconditioning with repeated clamping of the aorta will never get widespread use. If the "preconditioning reponse" is to be exploited in cardiac surgery, targeting the underlying molecular mechanisms must provide easily applicable techniques or drugs, which are shown in large scale clinical studies to be beneficial.




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