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Ann Thorac Surg 2003;75:1246-1252
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

Ischemic preconditioning does not improve myocardial preservation during off-pump multivessel coronary operation

^a Department of Anesthesiology, Oulu University Hospital, Oulu, Finland
^b Department of Cardio-Thoracic Surgery, Oulu University Hospital, Oulu, Finland
^c Oulu, Department of Medical Biochemistry, Oulu University, Oulu, Finland
^d Department of Internal Medicine, Kuopio University Hospital, Kuopio, Finland

Accepted for publication October 16, 2002.

^* Address reprint requests to Dr Penttilä, Department of Anesthesiology, Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
e-mail: hannu.penttila{at}tyks.fi

BACKGROUND: The value of ischemic preconditioning during coronary operations has remained controversial. The aim of this study was to evaluate the effects of ischemic preconditioning on myocardial energy metabolism and tissue injury during off-pump multivessel coronary surgery.

METHODS: Eleven patients with preceding preconditioning were compared with 11 patients without it. The preconditioning group underwent a 5-minute period of ischemia followed by a 5-minute reperfusion period before coronary occlusion for each of the first two anastomoses.

RESULTS: The transmyocardial differences (coronary sinus – arterial) in inosine and the sum of adenine degradation products increased in both groups, but the differences in xanthine and hypoxanthine increased only in the preconditioning group. Myocardial lactate production increased to a maximum of 0.09 mmol/L with preconditioning and to a maximum of 0.17 mmol/L without it. Transmyocardial pH differences increased to 0.03 U in both groups. The maximum postoperative concentration of creatine kinase-MB mass was 14.8 µg/L with preconditioning and 6.3 µg/L without preconditioning, and that of troponin I 7.4 µg/L and 5.2 µg/L, respectively. There were no statistically significant differences between the groups, however.

CONCLUSIONS: Ischemic preconditioning of 5 minutes followed by reperfusion of 5 minutes during off-pump multivessel coronary artery surgery did not prevent myocardial metabolic derangement and tissue injury and thus cannot be routinely recommended.

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