Basic Research in Cardiology

, Volume 106, Issue 4, pp 511–519 | Cite as

Remote intermittent ischemia before coronary artery bypass graft surgery: a strategy to reduce injury and inflammation?

  • Partheeban Karuppasamy
  • Sanjay Chaubey
  • Tracy Dew
  • Rebecca Musto
  • Roy Sherwood
  • Jatin Desai
  • Lindsay John
  • Ajay M. Shah
  • Michael S. Marber
  • Gudrun KunstEmail author
Original Contribution


Perioperative myocardial ischemia contributes to postoperative morbidity and mortality. Remote intermittent ischemia (RI) has been shown to benefit patients undergoing coronary artery bypass graft (CABG) surgery by decreasing postoperative cardiac troponin levels. In addition, there is evidence that volatile anesthetics may provide myocardial protection. In this prospective randomized controlled trial we tested the hypothesis that RI is cardioprotective under a strict anesthetic regime with volatile anesthesia until cardiopulmonary bypass (CPB). We also assessed whether RI modulates postoperative cytokine and growth factor concentrations. Fifty-four patients referred for elective CABG surgery without concomitant valve or aortic surgery were randomized to three 5-min cycles of left upper limb ischemia by cuff inflation (RI) or placebo without cuff inflation (Plac). All patients received the volatile anesthetic isoflurane (1.15–1.5 vol%) before CPB and the intravenous anesthetic propofol (3–4 mg/kg/h) thereafter until the end of surgery. Cardiac arrest during CPB was induced by intermittent cross-clamp fibrillation, or by blood cardioplegia. We excluded patients older than 85 years, with unstable angina, significant renal disease, and those taking sulfonylureas. Troponin I (cTnI) was measured preoperatively and after 6, 12, 24 and 48 h. In addition, brain natriuretic peptide (BNP), creatine kinase (CKMB) and a panel of cytokines and growth factors were analyzed perioperatively. Although cTnI, BNP and CKMB all increased post-CABG, there were no significant differences between RI and Plac groups; area under the curve for cTnI 189.4 (183.6) ng/mL/48 h and 183.0 (155.2) ng/mL/48 h mean (SD), p = 0.90, respectively, despite a tendency to a shorter (p < 0.07) cross-clamp time in the treatment group. Similarly, there were no differences between groups in the central venous concentrations of numerous cytokines and growth factors. In patients undergoing CABG surgery RI does not provide myocardial protection under a strict anesthetic regime with volatile anesthesia until CPB, and RI was not associated with changes in cytokines.


Cardioprotection Coronary artery disease Bypass surgery Inflammation Myocardial ischemia Preconditioning 



The authors acknowledge the support of all nursing staff at the Cardiac Recovery and Victoria and Albert High Dependency Units, and the additional statistical advice by Dr Toby Prevost. The financial support from the Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust is also acknowledged. This study was supported by a grant from the Department of Research and Development, King’s College Hospital Foundation Trust, London.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Partheeban Karuppasamy
    • 1
  • Sanjay Chaubey
    • 2
  • Tracy Dew
    • 3
  • Rebecca Musto
    • 3
  • Roy Sherwood
    • 3
  • Jatin Desai
    • 2
  • Lindsay John
    • 2
  • Ajay M. Shah
    • 4
  • Michael S. Marber
    • 5
  • Gudrun Kunst
    • 1
    Email author
  1. 1.Department of Anaesthetics, Intensive Care Medicine and Pain TherapyKing’s College Hospital NHS Foundation TrustLondonUnited Kingdom
  2. 2.Department of Cardiothoracic SurgeryKing’s College Hospital NHS Foundation TrustLondonUnited Kingdom
  3. 3.Department of Clinical BiochemistryKing’s College Hospital NHS Foundation TrustLondonUnited Kingdom
  4. 4.Cardiovascular Division, James Black Centre, King’s Denmark Hill CampusKing’s College London BHF Centre of ExcellenceLondonUnited Kingdom
  5. 5.Cardiovascular Division, The Rayne Institute, St Thomas’ HospitalKing’s College London BHF Centre of ExcellenceLondonUnited Kingdom

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