Objective -To test the hypothesis that short periods of ischemia may increase the myocardial protection obtained with intermittent crossclamping of the aorta.
Methods -In the control group (18 patients)Despite theoretical criticism of the technique of intermittent crossclamping of the aorta with hypothermia at 32ºC, the simplicity of the procedure and its good clinical results have led several surgeons to use it, particularly in myocardial revascularization surgery 1,2 .In Brazil, Jatene et al 3 have been using it since 1969, with good clinical results. A few randomized studies 4,5 comparing the efficacy of intermittent crossclamping of the aorta with the use of cardioplegic solutions exist, but none of them conclude that one method is superior to the others.One question about the technique is that the repetition of ischemic episodes, which are individually reversible, may cause cumulative damage resulting in necrosis. Reimer et al 6 disproved this concept by showing experimentally that intermittent reperfusion avoids cumulative metabolic deficit and myocardial ischemia with cell death and that the first episode of ischemia reduces the consumption of high energy phosphates in subsequent episodes. Other studies 7 have shown that short periods of ischemia do not induce irreversible cellular damage and that they do not result in cumulative metabolic, structural, and functional deficits. It has also been reported that, paradoxically, short periods of ischemia increase the tolerance of the heart instead of making it more vulnerable to subsequent ischemic episodes. This induction of tolerance to ischemia is called ischemic preconditioning 8 .The objective of this study was to assess the influence of ischemic preconditioning on myocardial protection obtained with intermittent crossclamping of the aorta in patients undergoing myocardial revascularization.