Myocardial preconditioning in surgery for coronary heart disease

Ischemic and reperfusion injury is a relevant problem in surgery for coronary heart disease, since the recovery of blood flow in the ischemic region of the myocardium can lead to damage to cardiomyocytes due to adverse metabolic changes. Ischemic and pharmacological preconditioning are effective cardioprotective methods for interventions on the coronary arteries due to the activation of mitochondrial ATP-sensi-tive potassium channels. Despite widespread of these cardiac protection techniques in cardiac surgery, they require careful examination as part of endovascular surgery. At the same time, an effective method of intraoperative control of ischemia is reperfusion - intracoronary electrocardiography. Thus, myocardial preconditioning using physical factors and pharmacological agents appear promising method of protecting the heart from ischemic reperfusion damage during interventions on the coronary arteries requiring a comprehensive assessment of efficacy in clinical practice. Unification of existing instrumental and laboratorial ischemia control methods are needed to minimize surgical aggression in endovascular surgery.