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J Thorac Cardiovasc Surg 2001;122:972-978
© 2001 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology (CSP)

The protective effects of preconditioning decline in aged patients undergoing coronary artery bypass grafting

Zhong-Kai Wu, MDa, Erkki Pehkonen, MDa, Jari Laurikka, MDa, Liisa Kaukinen, MDb, Eva L. Honkonen, MDb, Seppo Kaukinen, MDb, Pekka Laippala, PhDc,d, Matti R. Tarkka, MDa

From the Division of Cardiothoracic Surgery,a Department of Anesthesiology and Intensive Care,b Tampere University Hospital, Research Unit of Tampere University Hospital,c and the School of Public Health, Biometry Unit, University of Tampere,d Tampere, Finland.

Supported by the Research Foundation of Tampere University Hospital.

Received for publication Dec 20, 2000. Revisions requested April 13, 2001; revisions received May 1, 2001. Accepted for publication May 15, 2001. Address for reprints: Matti Tarkka, MD, Department of Surgery, Division of Cardiothoracic Surgery, Tampere University Hospital, 33521 Tampere, Finland (E-mail: matti.tarkka{at}tays.fi).

Abstract

Objective: We sought to investigate the effects of myocardial ischemic preconditioning in adult and aged patients undergoing coronary artery bypass grafting.
Methods: Eighty patients with 3-vessel disease undergoing coronary artery bypass grafting were randomized into one of the following groups: adult ischemic preconditioning, adult control, aged ischemic preconditioning, and aged control. Hemodynamic data and cardiac troponin I values were compared between the groups. The ischemic preconditioning groups received 2 periods of 2 minutes of ischemia, followed by 3 minutes of reperfusion. The Student t test, {chi}2 test, and analysis of variance for repeated measures were used for the statistical analysis.
Results: The baseline for right ventricular ejection fraction and cardiac index was similar. Right ventricular ejection fraction was depressed after the operation in all groups. Ischemic preconditioning significantly improved the recovery of right ventricular ejection fraction and cardiac index after the operation in adult patients (P = .013 and .001, respectively), but in the aged group there was no difference in the changes of ejection fraction and cardiac index (P = .232 and .889, respectively). The cardiac troponin I value in the adult patients subjected to ischemic preconditioning was lower than that in the adult control subjects (P = .046), but in aged patients undergoing ischemic preconditioning, the value was similar to that in aged control subjects (P = .897). Ischemic preconditioning also resulted in a shorter postoperative mechanical ventilation time and in less inotropic use in the adult group.
Conclusion: Ischemic preconditioning protects the heart from ischemic reperfusion injury in adult patients undergoing coronary artery bypass grafting. The beneficial effects of ischemic preconditioning are manifested as a better recovery of right ventricular and global hemodynamic function, cellular viability, and surgical outcome. The protective effect of ischemic preconditioning is diminished in aged patients undergoing coronary bypass.




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