Anesthetic Preconditioning and Myocardial Protection in Coronary Artery Bypass Grafting: A Review of Mechanisms and Clinical Outcomes

Coronary artery bypass grafting (CABG) carries a high risk of perioperative myocardial injury due to ischemia-reperfusion insult. Volatile anesthetics, including sevoflurane and isoflurane, have been found to mimic ischemic preconditioning and provide myocardial protection by activating mitochondrial and anti-inflammatory signaling pathways. This review examines peer-reviewed clinical trials, meta-analyses, and mechanistic studies to assess the evidence supporting anesthetic preconditioning in CABG. Mechanistically, volatile anesthetics act via mitochondrial KATP channel activation, modulation of apoptosis-related proteins, and suppression of systemic inflammation. Clinically, they are associated with reduced postoperative troponin levels, improved ventricular function, and shorter ICU stays compared to total intravenous anesthesia (TIVA). Although large-scale trials such as the MYRIAD study report mixed mortality outcomes, short-term cardioprotective effects are consistently observed. These findings support the strategic use of volatile anesthetics during CABG to enhance myocardial preservation and motivate further targeted research.