BackgroundCoronary artery bypass grafting (CABG) with cardioplegic cardiac arrest and cardiopulmonary bypass (CPB) is associated with myocardial injury. The aim of this study was to investigate whether a modified mechanical post-conditioning (MMPOC) technique has a myocardial protective effect by enhancing early metabolic recovery of the heart following revascularization.MethodsA prospective, randomized trial was conducted at a single-center university hospital performing adult cardiac surgery. Seventy-nine adult patients undergoing first-time elective isolated multivessel coronary artery bypass grafting were prospectively randomized to MMPOC or control group. Anesthetic, cardiopulmonary bypass, myocardial protection, and surgical techniques were standardized. The post reperfusion cardiac indices, inotrope use and biochemical-electrocardiographic evidence of myocardial injury were recorded. The incidence of postoperative complications was recorded prospectively.ResultsOperative characteristics, including CPB and aortic cross-clamp time, were similar between the two groups (p>0.05). The MMPOC group had lower troponin I and other cardiac biomarkers level post CPB and postoperatively, with greater improvement in cardiac indices (p<0.001). MMPOC shortened post surgery hospitalization from 9.1 ± 2.1 to 7.5 ± 1.6 days (p<0.001).ConclusionsMMPOC technique promotes early metabolic recovery of the heart during elective CABG, leading to better myocardial protection and functional recovery.
Bu çalışmada, abdominal aort cerrahisi sırasında, suprarenal arterlere klemp konulmasının böbrek üzerindeki olumsuz etkileri ve önleme stratejileri araştırıldı. Ça lış ma pla nı: Wistar sıçanların aortuna suprarenal bölgede klemp konularak, abdominal aortik cerrahiyi taklit eder şekilde, renal iskemi modeli oluşturuldu. İki siklus uygulanan ve 10 dk. iskemi, 10 dk. reperfüzyon şeklindeki iskemik önkoşullanma, karnitin ve iskemik önkoşullanma + karnitin protokolü uygulandı. Nefrektomi materyalleri ve serum örneklerinde histopatolojik ve biyokimyasal değişiklikler incelendi. Bul gu lar: İskemi-reperfüzyon hasarından histopatolojik olarak ve istatistiksel yönden etkilenen bölgenin renal tübüller olduğu tespit edildi. İki siklus şeklinde 10 dk. iskemi ve 10 dk. reperfüzyon uygulamalı iskemik önkoşullanma işleminin iskemi-reperfüzyon hasarının önlenmesinde şüpheli olduğu bulundu. Oral karnitinin renal iskemi-reperfüzyon hasarını histopatolojik olarak azaltmadığı, ancak serbest oksijen radikallerine karşı önemli bir savunma olan katalaz enzim aktivitesini dokuda belirgin biçimde artırdığı saptandı. So nuç: İskemi önkoşullanma ve karnitin, suprarenal kros-klemp gerektiren abdominal aort cerrahisi sırasında oluşabilecek renal iskemi-reperfüzyon hasarını belli oranlarda engelleyebilir.
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