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Remote ischaemic preconditioning - the current best hope for improved myocardial protection in cardiac surgery
  1. Ishtiaq Rahman (ishtiaq.rahman{at}uhb.nhs.uk)
  1. University Hospital Birmingham NHS Trust, United Kingdom
    1. Robert S Bonser (robert.bonser{at}uhb.nhs.uk)
    1. University Hospital Birmingham NHS Trust, United Kingdom

      Abstract

      Ischaemic preconditioning has been recognised as a major cardioprotective phenomenon for many years1, 2 Cycles of non-lethal ischaemia and reperfusion applied to the heart prior to a potentially lethal ischaemic insult have the capacity to reduce infarct size by >50%. More recently, it became apparent that the protection generated by this classical form of direct ischaemic preconditioning could be replicated when the non-lethal ischaemia was applied to one segment of the heart and the lethal ischaemia applied to a separate segment3. Thereafter, it became established that the same protection could also occur even if the pre-conditioning ischaemic stimulus was applied completely distant to the target organ requiring protection, i.e. transient ischaemia of a remote organ or limb could still generate protection for the organ being subsequently challenged by lethal ischaemia4. There is now clinical evidence, suggesting that this remarkable remote ischaemic preconditioning (RIPC) phenomenon may represent a simple, inexpensive, easily applied method of increasing cardioprotection during an array of interventional procedures that require a period of cardiac ischaemia to allow repair or intervention. Moreover, as it is now recognised that such protection may be achieved by starting the cyclical remote ischaemia and reperfusion after the period of injurious cardiac ischaemia has commenced; so called remote post- or peri-conditioning, the potential arises of enhancing protection in other scenarios, including transplantation5.

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