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).