OFFERS TO THE QUIESCENT HEART - EMADZARIE 2012
description
Transcript of OFFERS TO THE QUIESCENT HEART - EMADZARIE 2012
QUIESCENT HEART
Assiut University
E M A D Z A R I E F 2 0 1 2
HIDDEN DANGER
CARDIAC CONDITIONING
Remote Ischemic conditioning
CONCLUSION
THE HIDDEN DANGER
(CPB) and cardioplegic arrest remain the most popular
techniques in clinical intervention during open heart surgery
However both can directly or indirectly result in cardiac
morbidity following surgery Cardioplegic arrest can render the
heart quiescent but globally ischaemic and upon reperfusion
triggers myocardial injury (reperfusion injury )
Suleiman MS Halestrap AP Griffiths EJ Mitochondria a target for myocardial protectionPharmacol Ther Jan 2001 89(1)29ndash46
E M A D Z A R I E F 2 0 1 2
For further reduction in morbidity and mortality strategies to increase tissue tolerance to ischemia or reduce damage that occurs on reperfusion to be considered
One of the strategies that tries to protect the
heart is the CARDIAC CONDITIONING
E M A D Z A R I E F 2 0 1 2
THE HIDDEN DANGER
E M A D Z A R I E F 2 0 1 2
if these tissues have
already been exposed to several minor adverse or ischaemic events
medicationstress etc ie (conditioned )
Halogenated anesthetics
Noble gas e g Xenon
Opioids
Potassium channel openers
Nitric oxide donors
Bradykinin receptor agonists
phosphodiesterase inhibitors
AMP-activated protein kinase activators
muscarinic agents
Angiotensin AT1 agonists
Endothelin
E M A D Z A R I E F 2 0 1 2
heat
stress
rapid pacing
E M A D Z A R I E F 2 0 1 2
A number of noxious stimuli when applied sparingly
can trigger myocardial preconditioning eg
Gene therapy to induce a more permanent
and long-last preconditioning phenotype
E M A D Z A R I E F 2 0 1 2
eg Gene therapy for
eNOS and iNOS
E M A D Z A R I E F 2 0 1 2
ischemic
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Injury
Lack of energy substrates
Lost cell wall pump activity
Lost antioxidant defense
Lost pH and calcium homeostasis
Lost mitochondrial integrity
E M A D Z A R I E F 2 0 1 2
RIPC (inter organ) preconditioning
is a recent observation in which
brief ischemia of one organ
protection on distant organs
without direct stress to the organ
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
Skeletal muscle
Kidney
intestine
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
HIDDEN DANGER
CARDIAC CONDITIONING
Remote Ischemic conditioning
CONCLUSION
THE HIDDEN DANGER
(CPB) and cardioplegic arrest remain the most popular
techniques in clinical intervention during open heart surgery
However both can directly or indirectly result in cardiac
morbidity following surgery Cardioplegic arrest can render the
heart quiescent but globally ischaemic and upon reperfusion
triggers myocardial injury (reperfusion injury )
Suleiman MS Halestrap AP Griffiths EJ Mitochondria a target for myocardial protectionPharmacol Ther Jan 2001 89(1)29ndash46
E M A D Z A R I E F 2 0 1 2
For further reduction in morbidity and mortality strategies to increase tissue tolerance to ischemia or reduce damage that occurs on reperfusion to be considered
One of the strategies that tries to protect the
heart is the CARDIAC CONDITIONING
E M A D Z A R I E F 2 0 1 2
THE HIDDEN DANGER
E M A D Z A R I E F 2 0 1 2
if these tissues have
already been exposed to several minor adverse or ischaemic events
medicationstress etc ie (conditioned )
Halogenated anesthetics
Noble gas e g Xenon
Opioids
Potassium channel openers
Nitric oxide donors
Bradykinin receptor agonists
phosphodiesterase inhibitors
AMP-activated protein kinase activators
muscarinic agents
Angiotensin AT1 agonists
Endothelin
E M A D Z A R I E F 2 0 1 2
heat
stress
rapid pacing
E M A D Z A R I E F 2 0 1 2
A number of noxious stimuli when applied sparingly
can trigger myocardial preconditioning eg
Gene therapy to induce a more permanent
and long-last preconditioning phenotype
E M A D Z A R I E F 2 0 1 2
eg Gene therapy for
eNOS and iNOS
E M A D Z A R I E F 2 0 1 2
ischemic
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Injury
Lack of energy substrates
Lost cell wall pump activity
Lost antioxidant defense
Lost pH and calcium homeostasis
Lost mitochondrial integrity
E M A D Z A R I E F 2 0 1 2
RIPC (inter organ) preconditioning
is a recent observation in which
brief ischemia of one organ
protection on distant organs
without direct stress to the organ
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
Skeletal muscle
Kidney
intestine
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
THE HIDDEN DANGER
(CPB) and cardioplegic arrest remain the most popular
techniques in clinical intervention during open heart surgery
However both can directly or indirectly result in cardiac
morbidity following surgery Cardioplegic arrest can render the
heart quiescent but globally ischaemic and upon reperfusion
triggers myocardial injury (reperfusion injury )
Suleiman MS Halestrap AP Griffiths EJ Mitochondria a target for myocardial protectionPharmacol Ther Jan 2001 89(1)29ndash46
E M A D Z A R I E F 2 0 1 2
For further reduction in morbidity and mortality strategies to increase tissue tolerance to ischemia or reduce damage that occurs on reperfusion to be considered
One of the strategies that tries to protect the
heart is the CARDIAC CONDITIONING
E M A D Z A R I E F 2 0 1 2
THE HIDDEN DANGER
E M A D Z A R I E F 2 0 1 2
if these tissues have
already been exposed to several minor adverse or ischaemic events
medicationstress etc ie (conditioned )
Halogenated anesthetics
Noble gas e g Xenon
Opioids
Potassium channel openers
Nitric oxide donors
Bradykinin receptor agonists
phosphodiesterase inhibitors
AMP-activated protein kinase activators
muscarinic agents
Angiotensin AT1 agonists
Endothelin
E M A D Z A R I E F 2 0 1 2
heat
stress
rapid pacing
E M A D Z A R I E F 2 0 1 2
A number of noxious stimuli when applied sparingly
can trigger myocardial preconditioning eg
Gene therapy to induce a more permanent
and long-last preconditioning phenotype
E M A D Z A R I E F 2 0 1 2
eg Gene therapy for
eNOS and iNOS
E M A D Z A R I E F 2 0 1 2
ischemic
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Injury
Lack of energy substrates
Lost cell wall pump activity
Lost antioxidant defense
Lost pH and calcium homeostasis
Lost mitochondrial integrity
E M A D Z A R I E F 2 0 1 2
RIPC (inter organ) preconditioning
is a recent observation in which
brief ischemia of one organ
protection on distant organs
without direct stress to the organ
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
Skeletal muscle
Kidney
intestine
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
For further reduction in morbidity and mortality strategies to increase tissue tolerance to ischemia or reduce damage that occurs on reperfusion to be considered
One of the strategies that tries to protect the
heart is the CARDIAC CONDITIONING
E M A D Z A R I E F 2 0 1 2
THE HIDDEN DANGER
E M A D Z A R I E F 2 0 1 2
if these tissues have
already been exposed to several minor adverse or ischaemic events
medicationstress etc ie (conditioned )
Halogenated anesthetics
Noble gas e g Xenon
Opioids
Potassium channel openers
Nitric oxide donors
Bradykinin receptor agonists
phosphodiesterase inhibitors
AMP-activated protein kinase activators
muscarinic agents
Angiotensin AT1 agonists
Endothelin
E M A D Z A R I E F 2 0 1 2
heat
stress
rapid pacing
E M A D Z A R I E F 2 0 1 2
A number of noxious stimuli when applied sparingly
can trigger myocardial preconditioning eg
Gene therapy to induce a more permanent
and long-last preconditioning phenotype
E M A D Z A R I E F 2 0 1 2
eg Gene therapy for
eNOS and iNOS
E M A D Z A R I E F 2 0 1 2
ischemic
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Injury
Lack of energy substrates
Lost cell wall pump activity
Lost antioxidant defense
Lost pH and calcium homeostasis
Lost mitochondrial integrity
E M A D Z A R I E F 2 0 1 2
RIPC (inter organ) preconditioning
is a recent observation in which
brief ischemia of one organ
protection on distant organs
without direct stress to the organ
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
Skeletal muscle
Kidney
intestine
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
if these tissues have
already been exposed to several minor adverse or ischaemic events
medicationstress etc ie (conditioned )
Halogenated anesthetics
Noble gas e g Xenon
Opioids
Potassium channel openers
Nitric oxide donors
Bradykinin receptor agonists
phosphodiesterase inhibitors
AMP-activated protein kinase activators
muscarinic agents
Angiotensin AT1 agonists
Endothelin
E M A D Z A R I E F 2 0 1 2
heat
stress
rapid pacing
E M A D Z A R I E F 2 0 1 2
A number of noxious stimuli when applied sparingly
can trigger myocardial preconditioning eg
Gene therapy to induce a more permanent
and long-last preconditioning phenotype
E M A D Z A R I E F 2 0 1 2
eg Gene therapy for
eNOS and iNOS
E M A D Z A R I E F 2 0 1 2
ischemic
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Injury
Lack of energy substrates
Lost cell wall pump activity
Lost antioxidant defense
Lost pH and calcium homeostasis
Lost mitochondrial integrity
E M A D Z A R I E F 2 0 1 2
RIPC (inter organ) preconditioning
is a recent observation in which
brief ischemia of one organ
protection on distant organs
without direct stress to the organ
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
Skeletal muscle
Kidney
intestine
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
Halogenated anesthetics
Noble gas e g Xenon
Opioids
Potassium channel openers
Nitric oxide donors
Bradykinin receptor agonists
phosphodiesterase inhibitors
AMP-activated protein kinase activators
muscarinic agents
Angiotensin AT1 agonists
Endothelin
E M A D Z A R I E F 2 0 1 2
heat
stress
rapid pacing
E M A D Z A R I E F 2 0 1 2
A number of noxious stimuli when applied sparingly
can trigger myocardial preconditioning eg
Gene therapy to induce a more permanent
and long-last preconditioning phenotype
E M A D Z A R I E F 2 0 1 2
eg Gene therapy for
eNOS and iNOS
E M A D Z A R I E F 2 0 1 2
ischemic
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Injury
Lack of energy substrates
Lost cell wall pump activity
Lost antioxidant defense
Lost pH and calcium homeostasis
Lost mitochondrial integrity
E M A D Z A R I E F 2 0 1 2
RIPC (inter organ) preconditioning
is a recent observation in which
brief ischemia of one organ
protection on distant organs
without direct stress to the organ
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
Skeletal muscle
Kidney
intestine
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
heat
stress
rapid pacing
E M A D Z A R I E F 2 0 1 2
A number of noxious stimuli when applied sparingly
can trigger myocardial preconditioning eg
Gene therapy to induce a more permanent
and long-last preconditioning phenotype
E M A D Z A R I E F 2 0 1 2
eg Gene therapy for
eNOS and iNOS
E M A D Z A R I E F 2 0 1 2
ischemic
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Injury
Lack of energy substrates
Lost cell wall pump activity
Lost antioxidant defense
Lost pH and calcium homeostasis
Lost mitochondrial integrity
E M A D Z A R I E F 2 0 1 2
RIPC (inter organ) preconditioning
is a recent observation in which
brief ischemia of one organ
protection on distant organs
without direct stress to the organ
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
Skeletal muscle
Kidney
intestine
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
Gene therapy to induce a more permanent
and long-last preconditioning phenotype
E M A D Z A R I E F 2 0 1 2
eg Gene therapy for
eNOS and iNOS
E M A D Z A R I E F 2 0 1 2
ischemic
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Injury
Lack of energy substrates
Lost cell wall pump activity
Lost antioxidant defense
Lost pH and calcium homeostasis
Lost mitochondrial integrity
E M A D Z A R I E F 2 0 1 2
RIPC (inter organ) preconditioning
is a recent observation in which
brief ischemia of one organ
protection on distant organs
without direct stress to the organ
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
Skeletal muscle
Kidney
intestine
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
ischemic
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Injury
Lack of energy substrates
Lost cell wall pump activity
Lost antioxidant defense
Lost pH and calcium homeostasis
Lost mitochondrial integrity
E M A D Z A R I E F 2 0 1 2
RIPC (inter organ) preconditioning
is a recent observation in which
brief ischemia of one organ
protection on distant organs
without direct stress to the organ
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
Skeletal muscle
Kidney
intestine
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Injury
Lack of energy substrates
Lost cell wall pump activity
Lost antioxidant defense
Lost pH and calcium homeostasis
Lost mitochondrial integrity
E M A D Z A R I E F 2 0 1 2
RIPC (inter organ) preconditioning
is a recent observation in which
brief ischemia of one organ
protection on distant organs
without direct stress to the organ
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
Skeletal muscle
Kidney
intestine
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
Injury
Lack of energy substrates
Lost cell wall pump activity
Lost antioxidant defense
Lost pH and calcium homeostasis
Lost mitochondrial integrity
E M A D Z A R I E F 2 0 1 2
RIPC (inter organ) preconditioning
is a recent observation in which
brief ischemia of one organ
protection on distant organs
without direct stress to the organ
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
Skeletal muscle
Kidney
intestine
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
RIPC (inter organ) preconditioning
is a recent observation in which
brief ischemia of one organ
protection on distant organs
without direct stress to the organ
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
Skeletal muscle
Kidney
intestine
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
RIPC (inter organ) preconditioning
is a recent observation in which
brief ischemia of one organ
protection on distant organs
without direct stress to the organ
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
Skeletal muscle
Kidney
intestine
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
Skeletal muscle
Kidney
intestine
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
Brief ischemic episodes
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
cGMP-dependent protein kinase (cGMPPKG) pathway
reperfusion injury salvage kinase (RISK) pathway
survivor activating factor enhancement (SAFE) pathway
E M A D Z A R I E F 2 0 1 2
ischemic protection
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
The effects of the lsquofirst windowrsquo
or early preconditioning last 1ndash2 h
after which the protection wanes
The lsquosecond windowrsquo or late
preconditioning occurs 24 h
following the initial preconditioning
ischaemia and lasts for 48ndash72 h20
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
YELLON D M DOWNEY J M Physiol Rev 2003831113-1151
EARLY PHASE
where cellular signaling
cascades +amplification
immediate
cardioprotection
(SWOP) later phase
genetic re-programming
+ de novo synthesis of proteins
sustained cardioprotection
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
Tapuria N Kumar Y Habib MM Abu Amara M Seifalian AM Davidson BR
Remote ischemic preconditioning a novel protective method from ischemia reperfusion injury--a review
J Surg Res 2008 Dec150(2)304-30
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
E M A D Z A R I E F 2 0 1 2
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
RIPC CLASSIC
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
EARLY AND LATE PRECONDITIONING
E M A D Z A R I E F 2 0 1 2
Zhou WW Zeng DB Chen RW Liu J Yang GX Liu PB et al Limb ischemic preconditioning reduces heart and lung injury after an open
heart operation in infants
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
RI PRE AND POST CONDITIONING
E M A D Z A R I E F 2 0 1 2
Luo W Zhu M Huang R Zhang Y A comparison of cardiac postconditioning and remote pre-
conditioning in paediatric cardiac surgery Cardiol Young 201121266ndash70
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
CONCLUSION Endogenous lsquoconditioningrsquo
strategies can be applied prior to
or during ischaemia or at the
onset of reperfusion
RIPC beneficial in cardiac
surgery AAA surgery elective
PCI PPCI
Potential benefit in cardiac
arrest cardiac transplantation
stroke and other surgical
settings
E M A D Z A R I E F 2 0 1 2
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
REFERENCES
Asger Granfeldt1 David J Lefer2 and Jakob Vinten-Johansen Protective ischaemia in patients preconditioning
and Postconditioning Cardiovascular Research (2009) 83 234ndash246
Hausenloy DJ Mwamure PK Venugopal V Harris J Barnard M Grundy E et al Effect of remote ischaemic
preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery a randomised
controlled trial Lancet 2007370575ndash9
XIONG Jun LIAO Xu XUE Fu-shan YUAN Yu-jing WANG Qiang and LIU Jian-hua Remote ischemia conditioningmdashan
endogenous cardioprotective strategy from outside the heart Chinese Medical Journal 2011124(14)2209-2215
Robert Loveridge MA and Frank Schroeder MD DEAA Anaesthetic preconditioning Continuing Education in
Anaesthesia Critical Care amp Pain | Volume 10 Number 2 2010
Jakub Marczaka Rafał Nowickia Julita Kulbackab and Jolanta Saczkob Is remote ischaemic preconditioning of
benefit to patients undergoing cardiac surgery Interactive CardioVascular and Thoracic Surgery 14 (2012) 634ndash
639
E M A D Z A R I E F 2 0 1 2
EMAD ZARIEF 2012
EMAD ZARIEF 2012