Remote Ischemic Preconditioning: The Surgeon’s Perspective

Since cardiac surgery began, surgeons have aimed to find methods of
minimizing myocardial injury resulting from ischemia and reperfusion.
The concept of somehow conditioning the heart in order to attenuate
ischemia and reperfusion-related injury has evolved in cardiovascular
research over decades, from ischemic preconditioning and
postconditioning to, more recently, remote ischemic preconditioning (and
postconditioning). Although many strategies have proven to be
beneficial in the experimental arena, a few have been successfully
translated into clinical practice. Remote ischemic preconditioning, with
the use of brief episodes of ischemia and reperfusion of vascular
territories remote from the heart, has been shown convincingly to
decrease myocardial injury. To date, the translation of this powerful
innate mechanism of myocardial and/or multiorgan protection from the
animal lab to the operating theatre, using transient occlusion of blood
flow to the upper limb with a blood-pressure cuff before cardiac
surgery, has shown promising results, with several proof-of-principle
and first randomized controlled clinical trials reporting benefits for
patients undergoing cardiac surgery. If the efficacy of remote ischemic
preconditioning can be conclusively proven, the clinical applications in
cardiac surgery could be almost infinite, providing multiorgan
protection in various surgical scenarios.