Role of preconditioning in cardiac surgery

The modalities of pharmacologically-induced preconditioning, although intellectually appealing, remain to be determined including the choice of the optimal agents and regimens. Benefits should be measured through clinical endpoints such as improved immediate or late myocardial function or perhaps improved survival in certain subgroups of patients such as those with problematic cardioplegia delivery or poor ventricular function. These considerations must be addressed before recommending the routine application of techniques or pharmacologic interventions. The only clinical situation in which the ischemic preconditioning remains logical would be “offpump” minimally invasive cardiac surgery as the occlusion of the target vessel during construction of the distal anastomosis most closely mimics the experimental scenario that has turned out to result in reduction of regionally-induced ischemic damage.