Copyright © 2006, European Society of Cardiology
Clinical applicability of preconditioning and postconditioning: The cardiothoracic surgeons's view
Toronto General Hospital, University Health Network, Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
* Corresponding author. Alfredo and Teresa DeGasperis Chair in Heart Failure Surgery, Surgical Director, Heart Transplant Program, 4N464, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4. Tel.: +1 416 340 3562; fax: +1 416 340 3337. Email address: vivek.rao@uhn.on.ca
Received 5 December 2005; revised 21 January 2006; accepted 26 January 2006
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1. Introduction |
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"Any surgeon who operates upon the heart should lose the respect of his colleagues." Theodor Billroth
The field of cardiac surgery has progressed significantly since this 19th century quote from Dr Billroth. The ability to perform cardiac procedures was limited by the inability to support the circulation and to offer adequate myocardial protection. Cardiac surgery as a profession was made possible by our ability to translate experimental research into the clinical arena. Two major concepts allowed the feasibility of open-heart surgery: 1) the development of mechanical circulatory support and 2) our understanding of myocardial protection. Myocardial protection refers to all strategies that increase the myocardium's ability to withstand an ischemic insult. Ischemic and reperfusion injuries are principally responsible for cardiac failure, morbidity and mortality following cardiac surgery. Bigelow et al.'s original work on hypothermia, driven by the desire to protect the brain from ischemic insult, led to the discovery that
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2. Ischemic preconditioning |
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2.1 Clinical benefits of IPC
2.2 Strategies for inducing IPC
2.3 Clinical applicability of IPC
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3. Pharmacological preconditioning |
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4. Remote preconditioning and postconditioning |
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4.1 Remote preconditioning
4.2 Postconditioning
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5. Conclusions |
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