Cardioprotection during cardiac surgery

Abstract

Coronary heart disease (CHD) is the leading cause of morbidity and mortality worldwide. For a large number of patients with CHD, coronary artery bypass graft (CABG) surgery remains the preferred strategy for coronary revascularization. Over the last 10 years, the number of high-risk patients undergoing CABG surgery has increased significantly, resulting in worse clinical outcomes in this patient group. This appears to be related to the ageing population, increased co-morbidities (such as diabetes, obesity, hypertension, stroke), concomitant valve disease, and advances in percutaneous coronary intervention which have resulted in patients with more complex coronary artery disease undergoing surgery. These high-risk patients are more susceptible to peri-operative myocardial injury and infarction (PMI), a major cause of which is acute global ischaemia/reperfusion injury arising from inadequate myocardial protection during CABG surgery. Therefore, novel therapeutic strategies are required to protect the heart in this high-risk patient group. In this article, we review the aetiology of PMI during CABG surgery, its diagnosis and clinical significance, and the endogenous and pharmacological therapeutic strategies available for preventing it. By improving cardioprotection during CABG surgery, we may be able to reduce PMI, preserve left ventricular systolic function, and reduce morbidity and mortality in these high-risk patients with CHD.

Gender and age-dependent differences in body composition changes in response to cardiac rehabilitation exercise training in patients after coronary artery bypass grafting

“…However, it does not induce any statistically significant change in body composition in older women. The creation of new therapeutic strategies within the scope of CR may be of significance with an ageing population, as highlighted by [18].…”

Propofol cardioprotection for on-pump aortocoronary bypass surgery in patients with type 2 diabetes mellitus (PRO-TECT II): a phase 2 randomized-controlled trial

“…Cardiac events in the isoflurane group could have arisen by chance or could be secondary to other factors, including microembolization, inadequate revascularization, or other mediators of cardiac injury. 1,6 In patients without diabetes, we cannot differentiate between the nonexistence of effect and the lack of power to detect it. Our clinical observations from the diabetes subgroup require further validation.…”

“…1 Patients with advanced age, diabetes, or low preoperative ventricular ejection fraction are at a particularly high risk for these complications. [1][2][3] Low cardiac output syndrome (LCOS) secondary to myocardial stunning or necrosis increases postoperative mortality by as much as ten to 17-fold. 3 It is essential to develop a preemptive intraoperative therapeutic strategy to counter these effects.…”

Ischemic Conditioning as an Adjunct to Percutaneous Coronary Intervention

“…12 From a clinical standpoint, the benefit derived from ischemic preconditioning was, for the most part, limited to a reduction in enzymatically defined myocardial necrosis in an elective PCI setting 13 and in the cardiac surgery setting. 14 The ongoing controversy surrounding the clinical relevance of biomarker-defined periprocedural myocardial injury, 15,16 and the large scale of most contemporary PCI trials represent missed opportunities for rigorous testing of the hypothesis that ischemic preconditioning confers meaningful clinical benefit. In the 1 study with longer term follow-up of patients undergoing PCI with adjunctive ischemic preconditioning, a clinical benefit was observed.…”