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Ischemic preconditioning does not improve myocardial preservation during off-pump multivessel coronary operation  Hannu J Penttilä, MD, Martti V.K Lepojärvi,

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Presentation on theme: "Ischemic preconditioning does not improve myocardial preservation during off-pump multivessel coronary operation  Hannu J Penttilä, MD, Martti V.K Lepojärvi,"— Presentation transcript:

1 Ischemic preconditioning does not improve myocardial preservation during off-pump multivessel coronary operation  Hannu J Penttilä, MD, Martti V.K Lepojärvi, MD, PhD, Päivi K Kaukoranta, MD, PhD, Kai T Kiviluoma, MD, PhD, Kari V Ylitalo, MD, PhD, Keijo J Peuhkurinen, MD, PhD  The Annals of Thoracic Surgery  Volume 75, Issue 4, Pages (April 2003) DOI: /S (02)

2 Fig 1 Study design and blood sampling schedule. (IPC = ischemic preconditioning [an ischemic period of 5 minutes followed by reperfusion for 5 minutes]; Time [T]0 = before bypass grafting; T1–T2 = immediately after the completion of the first two distal anastomoses; T3–T4 = 5 and 15 minutes after the suturing of the last anastomosis; T5–T6 = 2 and 8 hours after the suturing of the last anastomosis; T7–T10 = first to fourth postoperative day.) The Annals of Thoracic Surgery  , DOI: ( /S (02) )

3 Fig 2 Coronary occlusion times (means and 95% confidence intervals), ischemic preconditionings for the first two bypass grafts, and a list of the first two bypassed coronaries. (CI = confidence interval; Cx = circumflex coronary artery and its branches; Dg = diagonal coronary artery; IPC = ischemic preconditioning; LAD = left anterior descending coronary artery; RCA = right coronary artery and its branches; T0–T2 = sampling times [Fig 1].) The Annals of Thoracic Surgery  , DOI: ( /S (02) )

4 Fig 3 Myocardial lactate production (top) and transcardiac pH difference (bottom) (median, 25% and 75% percentiles, and non-outlier range) before grafting (T0), after the completion of the first (T1) and second (T2) distal anastomoses, and five (T3) and 15 (T4) minutes after the completion of all the anastomoses (Fig 1). The increase in myocardial lactate production was significant after the first anastomosis (p = 0.05) with ischemic preconditioning and after the second anastomosis without preconditioning (p = 0.04). The increase of the transcardiac pH difference was significant in both groups (p < 0.001). There were no differences between the groups. (IPC = ischemic preconditioning.) The Annals of Thoracic Surgery  , DOI: ( /S (02) )

5 Fig 4 Plasma levels of creatine kinase-MB (CK-MB) mass (top) and cardiac troponin I (bottom) (median, 25% and 75% percentiles, and non-outlier range) before construction of the anastomoses (T0), at 2 (T5) and 8 (T6) hours after the suturing of the last anastomosis, and on the next 4 days (T7–T10) (Fig 1). There were no statistically significant differences between the groups. (IPC = ischemic preconditioning.) The Annals of Thoracic Surgery  , DOI: ( /S (02) )


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