This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Galiñanes, M. Articles by Hearse, D. J. Search for Related Content PubMed Articles by Galiñanes, M. Articles by Hearse, D. J.

(Circulation. 1995;92:389-394.)
© 1995 American Heart Association, Inc.

Articles

Can Ischemic Preconditioning Ensure Optimal Myocardial Protection When Delivery of Cardioplegia Is Impaired?

Manuel Galiñanes, MD, PHD; Vincenzo Argano, MD, FRCS; David J. Hearse, DSc

From the Department of Cardiovascular Research, The Rayne Institute, St Thomas' Hospital, London, UK.

Correspondence to Manuel Galiñanes, MD, PhD, Cardiovascular Research, The Rayne Institute, St Thomas' Hospital, London SE1 7EH, UK.

Background Ischemic preconditioning is a potent protective intervention that is effective in all species studied. We have previously shown it to be as effective as cardioplegia; however, we have also shown that their combined use does not afford greater protection than the use of either alone. In the present study we investigated whether coincident ischemic preconditioning could compensate for inadequate cardioplegic protection when the delivery of cardioplegia was impaired, such as occurs in the presence of severe coronary stenosis or occlusion.

Methods and Results Isolated rat hearts were subjected to 30 minutes of global ischemia followed by 40 minutes of reperfusion. Four groups of hearts (n=12 per group) were studied: group 1, controls (no intervention); group 2, cardioplegia administered to hearts with a proximally occluded coronary artery; group 3, ischemic preconditioning applied before ischemia; and group 4, ischemic preconditioning and cardioplegia given in combination to hearts with a proximally occluded coronary artery. The postischemic recovery of left ventricular (LV) developed pressure (LVDP), expressed as a percentage of preischemic values, was significantly greater (P<.05) in preconditioned hearts (64±3%) than in control hearts (24±4%) or hearts treated with suboptimal cardioplegia (43±5%). Hearts with preconditioning plus cardioplegia recovered to an extent similar to that seen with preconditioning alone (59±2%). LV end-diastolic pressure was greater in control hearts (58±4 mm Hg) than in hearts with cardioplegia (41±4 mm Hg; P<.05 versus group 1) despite the incomplete delivery of the cardioplegia; the best protection was observed in preconditioned hearts and hearts with preconditioning plus cardioplegia (24±1 and 26±2 mm Hg, respectively; P<.05 versus groups 1 and 2).

Conclusions When the delivery of cardioplegia was impaired, myocardial protection (postischemic LVDP) was better served by ischemic preconditioning. Under the same conditions, the combination of cardioplegia plus preconditioning afforded superior protection compared with cardioplegia alone. These results may be of clinical interest since most patients who undergo surgery for ischemic heart disease suffer from severe coronary artery lesions that can prevent the adequate delivery of cardioplegia.

Key Words: cardioplegia • ischemia • reperfusion • occlusion

This article has been cited by other articles:

				H. J. Penttila, M. V.K. Lepojarvi, P. K. Kaukoranta, K. T. Kiviluoma, K. V. Ylitalo, and K. J. Peuhkurinen Ischemic preconditioning does not improve myocardial preservation during off-pump multivessel coronary operation Ann. Thorac. Surg., April 1, 2003; 75(4): 1246 - 1252. [Abstract] [Full Text] [PDF]

				B. Faris, J. Peynet, M. Wassef, A. Bel, C. Mouas, M. Duriez, and P. Menasche Failure of Preconditioning to Improve Postcardioplegia Stunning of Minimally Infarcted Hearts Ann. Thorac. Surg., December 1, 1997; 64(6): 1735 - 1741. [Abstract] [Full Text]

				L. P. Perrault, P. Menasche, K. V. Ylitalo, and K. J. Peuhkurinen Ischemic Preconditioning Before Normothermic Retrograde Cardioplegia Ann. Thorac. Surg., December 1, 1997; 64(6): 1874 - 1876. [Full Text]

				P. K. Kaukoranta, M. P. K. Lepojarvi, K. V. Ylitalo, K. T. Kiviluoma, and K. J. Peuhkurinen Normothermic Retrograde Blood Cardioplegia With or Without Preceding Ischemic Preconditioning Ann. Thorac. Surg., May 1, 1997; 63(5): 1268 - 1274. [Abstract] [Full Text]

				P. Menasche, C. Mouas, and C. Grousset Is Potassium Channel Opening an Effective Form of Preconditioning Before Cardioplegia? Ann. Thorac. Surg., June 1, 1996; 61(6): 1764 - 1768. [Abstract] [Full Text]

				I. B. Krukenkamp and S. Levitsky Myocardial Protection: Modern Studies Ann. Thorac. Surg., May 1, 1996; 61(5): 1581 - 1582. [Full Text]