Myocardial preconditioning
Described in 1986 by Murry et al. myocardial ischaemic preconditioning
(IPC) is a process whereby the heart undergoes multiple cycles of
ischaemia followed by reperfusion, prior to surgery to prevent
subsequent ischaemic-reperfusion injury (IRI) during
surgery(35). Years later, the concept of remote IPC
(RIPC) was introduced by Przyklenk and colleagues, which describes a
procedural site away from the protected area, such as cross clamping the
right side of the heart to protect the left(36). Since
the introduction of IPC, multiple studies have been conducted to
determine the beneficial outcomes of its use. A trial conducted in 2013
by Thielmann and colleagues studied the prognostic effects of RIPC of
the left upper arm, in patients CABG(37). They
concluded that all-cause mortality was reduced in patients treated with
RIPC than those without(37).