[The role of ischemic preconditioning in off-pump CABG: is it really necessary to accomplish scrupulous ischemic...

In an attempt to avoid the deleterious effect of cardiopulmonary bypass, off-pump coronary artery bypass grafting has been rediscovered and spread. We often accomplish the ischemic preconditioning (IP) in off-pump CABG. IP is the phenomenon in which sublethal episode of myocardial ischemia result in increased tolerance to a later, potentially lethal, episode of ischemia. To evaluate the cardioprotective effect of IP and an ATP-sensitive potassium channel (KATP) opener, oxidative radical scavenger, 43 clinical cases were examined. The myocardial tissue oxygen saturation was measured by near-infra red spectroscopy during IP. Twelve cases were subjected to accomplish simple IP (5 min x twice), and 29 cases received pharmacological IP (administrated allopurinol preoperatively and nicorandil intraoperatively; 3 min x once). The result showed that the tissue oxygen of pharmacological IP group is superior to that of simple IP group. The concomitant use of IP and KATP opener, oxidative radical scavenger both ameliorated cardiac dysfunction during the ischemia in anastomotic occlusion of the coronary artery, and improved the postischemic functional recovery. These results suggest that we would be able to decrease both duration and the number of times of IP by using KATP opener and oxidative radical scavenger.