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European Journal of Cardio-Thoracic Surgery, Vol 8, 270-275, Copyright © 1994 by European Association for Cardio-thoracic Surgery
AM Alkhulaifi, DM Yellon and WB Pugsley
Ischaemic preconditioning, with brief periods of ischaemia separated by
reperfusion, increases myocardial resistance to infarction. In addition,
preconditioning leads to preservation of myocardial adenosine triphosphate
(ATP) during ischaemia. We propose that ischaemic preconditioning may share
fundamental similarities with intermittent aortic cross-clamping utilised
during aorto-coronary bypass surgery. The aim of this study was to test the
hypothesis that controlled aortic cross-clamping is a form of
preconditioning using conservation of ATP as the end point. Patients
randomised to the preconditioned group (preconditioned, n = 10 patients),
received a preconditioning stimulus of two 3-min periods of cross-clamping
separated by 2 min of reperfusion prior to an ischaemic insult of 10 min
ischaemia and ventricular fibrillation. In the control group (control, n =
10 patients) hearts received 10 min cross-clamping with fibrillation
without prior preconditioning. Myocardial ATP, creatine phosphate (CP), and
lactate were determined from biopsy specimens taken at the onset of
cardiopulmonary bypass (A), at the end of preconditioning (B), and at the
end of 10 min of ischaemic insult (C). Results: expressed as mean +/- SE
(mumol/g dry weight). Preconditioning resulted in a significant depletion
of the myocardial ATP content (preconditioned, B: 11.7 +/- 0.9 vs A: 19.8
+/- 1.4; P < 0.01). Furthermore 10 min of ischaemia resulted in a
significant depletion of ATP in the control patients (control, C: 7.2 +/-
0.3 vs B: 19.5 +/- 1.2; P < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Preconditioning the human heart during aorto-coronary bypass surgery
Department of Cardiothoracic Surgery, Middlesex Hospital, London, UK.
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