Comparison between local and remote ischemic conditioning in coronary artery bypass graft surgery
Abstract
Introduction: Brief periods of ischemia prior to coronary artery bypass graft surgery may limit myocardial damage produced by the ischemia-reperfusion phenom-enon.
Objective: To compare the effect of local and remote ischemic conditioning, in relation to the behavior of enzyme levels (TnT and CPK-MB) and major adverse cardiac events in the postoperative period.
Method: A quasi-experimental, explanatory, comparative study was carried out in two groups of 31 and 30 patients proposed for coronary artery bypass graft surgery. In the first group (remote ischemic conditioning) a tourniquet was placed on the right arm, alternating three insufflations with three de-insufflations, at a pressure of 200 mmHg and maintained for five minutes each, before, during and after the major ischemic event caused by coronary artery clamping. In the other group (local ischemic conditioning) the left anterior descending artery was clamped and unclamped —three times during ten seconds— before and after coronary artery bypass graft surgery.
Results: No significant differences were found in enzyme values (TnT and CPK-MB) or incidence of major adverse cardiac events in the first postoperative week: ventricular fibrillation (53.4 vs. 34.8%; p=0.347), low cardiac output (32.0 vs. 20.2%; p=0.524) and occurrence of a new acute myocardial infarction (25.9 vs. 15.8%; p= 0.418).
Conclusions: Both procedures are important tools to consider for myocardial protection in coronary artery bypass graft surgery.
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