O pré-condicionamento isquêmico influencia a contratilidade ventricular na cirurgia sem extracorpórea

Abstract

Background: Ischemic preconditioning is a method that prepares and protects cells to tolerate a long period of ischemia with the least possible injury.

Myocardial conditioning techniques in off-pump coronary artery bypass grafting

“… Post-op EF IP and adenosine did not elicit statistically significant EF preservation compared to the control group No difference found in post-op EF and enzymes release in between groups. Incidence of arrhythmias was higher in the IP group but did not reach statistical significance 20 Adenosine IP induced with twice 2 min LAD occlusion followed 3 min reperfusion before the first anastomosis Arrhythmias 20 IP Troponin/CK-MB 20 Control Hong et al ( 2012 ) Circulation Journal, Japan [ 18 ] Prospective controlled randomized trial Seventy OPCAB Lower limb 4 cycles of 5 min ischemia and 5 min of reperfusion before anastomoses (RIPC) and after anastomoses (RIPostC) Troponin release RIPC + RIPostC significantly reduced postoperative serum troponin I levels RIPC + RIPostC decreased postoperative myocardial enzyme elevation by almost half postoperatively in patients undergoing OPCAB 35 RIPC + RIPpostC 35 Control Hong et al ( 2010 )] Anaesth Intensive Care, Korea [ 19 ] Prospective randomized controlled trial 130 OPCAB Upper limb 4 cycles of 5 min ischemia and 5 min of reperfusion after anesthesia Troponin release Troponin release was lower in the RIPC group but was not statistically significant RIPC did not reduce significantly post-operative myocardial enzyme release 65 RIPC 65 Control Succi et al ( 2010 ) Arq Bras Cardiol, Brasil [ 20 ] Prospective controlled randomized trial Forty OPCAB IP induced with twice 1 min LAD occlusion followed 2 min reperfusion before the anastomosis Intra-op EF (measured pulsed Doppler of the descending thoracic aorta) Acceleration of the aortic blood flow with no differences in between groups; IP group maintained left ventricular contractility during the entire procedure while the control group presented significant reduction in left ventricular contractility IP prevented the decrease in left ventricular contractility during off-pump myocardial revascularization surgery 0 IP 20 Control Drenger et al ( 2008 ) Journal of Cardiothoracic and Vascular Anesthesia, Israel [ 21 ] Prospective controlled randomized trial Twenty five OPCAB IP induced with single 5 min LAD occlusion follo...…”

“…Troponin release was lower in the RIPC group but did not reach statistical significance (p = 0.172) [ 19 ]. Succi et al [ 20 ] reported that IP, induced only by 1 minutes of LAD occlusion followed by 2 minutes of reperfusion before anastomosis prevented decrease in left ventricular contractility Hong et al [ 18 ] used both RIPC and postconditioning (PostC) in a cohort of 35 OPCAB patients. Ischemic remote preconditioning and PostC were elicited with 4 cycles of 5 minutes of ischemia and 5 minutes of reperfusion of the lower limb before and after anastomosis.…”

“…Same Authors [ 18 ], however, studied the effect of RIPC and PostC together and they observed, this time, a reduction of troponin release in a series of OPCAB. All the other trials [ 13 , 14 , 17 , 20 - 22 , 48 ] carried out in OPCAB with conditioning used ‘central preconditioning’, hence eliciting protection by cycles of occlusion/reperfusion at the level of targeted vessel. All of them led to different and non-homogeneous results.…”

“…Central remote ischemic preconditioning has been, however, fairly dismissed in on pump cardiac surgery and during interventional cardiology procedure for its impracticality and its high level of invasiveness [ 2 , 3 , 49 ]. It is important to stress that some of the RIPC and central IP trials did not state the type of anesthesia used [ 13 , 23 ], or deliberately used propofol as anesthetic maintenance [ 12 , 16 - 18 , 20 ], while very few did not use it [ 19 , 21 , 22 ]. Recently it has been reported that propofol may inhibit preconditioning effect, and large trials have intentionally avoided it use [ 50 ].…”