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Original Articles: Adult Cardiac

Invited Commentary

Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104-4283

(Email: yiandoc{at}hotmail.com).

The perioperative protection of the heart from injury caused by ischemia and reperfusion remains a major goal in cardiac surgery. Advances in cardioplegia have steadily improved perioperative myocardial protection, but there is still room for further improvement.

A protective modality that has been increasingly recognized is myocardial preconditioning that can be induced by various stimuli such as ischemia, volatile anesthetics, levosimendan, and electrical stimulation [1–3]. Yang and colleagues [3] report their pilot evaluation of preoperative electroacupuncture in 60 patients undergoing left-sided valve replacement under total intravenous anesthesia. In this randomized study, they demonstrate that myocardial preconditioning with electroacupuncture significantly decreased troponin leak, inotropic support, and need for intensive care.

I congratulate these investigators for highlighting the clinical relevance of this intervention. As the authors note, further trials are indicated to determine more fully the clinical benefits and definitive mechanisms of this therapeutic approach.

This type of trial contributes to the growing body of evidence that demonstrates the outcome benefits of myocardial preconditioning [1, 2]. The published trials have mainly evaluated efficacy; for example, which interventions induce myocardial preconditioning with measurable clinical benefit. The likely progression in this clinical research will be to evaluate multiple interventions simultaneously, for example, volatile anesthesia and electroacupuncture throughout the practice of cardiac surgery for even greater patient benefit [4].

	References

Top References

 

1. Augoustides JG. The year in cardiothoracic and vascular anesthesia: selected highlights from 2008 J Cardiothorac Vasc Anesth 2009;23:1-7.[Medline]
2. Augoustides JG, Patel P. Recent advances in perioperative medicine: highlights from the literature for the cardiothoracic and vascular anesthesiologist J Cardiothorac Vasc Anesth 2009;23:430-436.[Medline]
3. Yang L, Yang J, Wang Q, et al. Cardioprotective effects of electroacupuncture pretreatment on patients undergoing heart valve replacement surgery: a randomized controlled trial Ann Thorac Surg 2010;89:781-786.[Abstract/Free Full Text]
4. Augoustides JG. Contemporary conduct of deep hypothermic circulatory arrest: possible roles of retrograde cerebral perfusion, anesthetic preconditioning, and aprotinin Ann Thorac Surg 2008;86:689.[Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): John G.T. Augoustides Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Augoustides, J. G.T. Search for Related Content PubMed PubMed Citation Articles by Augoustides, J. G.T. Related Collections Anesthesia Related Article