Boston-Griffiths, EA; (2013) Improving cardioprotection during cardiac bypass surgery. Doctoral thesis , UCL (University College London).

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Abstract

Ischaemic heart disease (IHD) is the leading cause of death worldwide and according to the World Health Organisation the number of patients with IHD will reach 19 million by 2020 if current trends continue. While coronary artery bypass graft (CABG) surgery remains the treatment of choice for the severest form of the disease, the detrimental effects of peri-operative myocardial injury particularly in the form of myocardial ischaemia-reperfusion injury (IRI) accounts for significant levels of morbidity and mortality particularly in high-risk patients. The past four decades have seen advances in cardioprotective strategies especially within the disciplines of cardioplegia and anaesthesia. Despite this, improvements in patient survival have been limited. Researchers and clinicians alike have called for novel ways of protecting the heart, directing their attention to cellular and mitochondrial pathways which may hold the key to improving survival. This thesis covers a fascinating exploration into the cardioprotective effects brought about by the inhibition of the mitochondrial permeability transition pore (mPTP) using cyclosporin A (CsA), as well as the role of remote ischaemic preconditioning (RIPC) in limiting the extent of myocardial injury in the setting of complex cardiac bypass surgery. In summary, this thesis examines both pharmacological and non-pharmacological strategies for protecting the heart in the setting of cardiac surgery. Despite decades of advancement in research within this field, the consequences of ischaemia-reperfusion injury remain ever-present. As a result, it is hoped that the research in this thesis will make a positive contribution to the body of evidence currently available for the benefit of patients with IHD.

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