Preconditioning the Brain and Heart: Implications for Cardiac Surgery

Abstract

Despite many recent advances in emboli detection, aortic imaging, myocardial preservation, and perfusion equipment, ischemic injury to the heart and brain remains a serious complications after cardiac surgery. Hypoperfusion (particularly in the heart) and microem boli (particularly in the brain) during cardiopulmonary bypass constitute the etiology of ischemia. Although hypothermia has traditionally been the mainstay for systemic protection from transient ischemia, there has been a general trend to accept warmer heart and core temperatures during bypass, which increases the poten tial for ischemic injury to various organs. This article discusses recent advances in the understanding of myocardial and brain preconditioning and their poten tial role to provide additional protection during cardiac surgery.