Multiorgan protection of remote ischemic perconditioning in valve replacement surgery

Hu, Qinghua; Luo, Wanjun; Huang, Lei; Huang, Rimao; Chen, Ri; Gao, Yang

doi:10.1016/j.jss.2015.06.053

Cited by 35 publications

(49 citation statements)

References 26 publications

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“…21 RCTs 17–37 with a total of 6302 patients met the inclusion criteria. 6 RCTs were conducted for isolated coronary artery bypass graft (CABG) 17, 22, 28–31 , 5 RCTs were done in isolated valve surgery 20, 21, 34, 35, 37 , and 10 RCTs included a combination of CABG and valve surgery 18, 19, 23–27, 32, 33, 36 . The ischemic protocol (cycles × I/R) was 3 × 5 min/5 min in 11 RCTs 17–19, 22, 26, 28, 29, 32, 35–37 , 4 × 5 min/5 min in 7 RCTs 24, 25, 27, 30, 31, 33, 34 , 3 × 10 min/10 min in 2 RCTs 20, 21 , and 2 × 5 min/5 min in 1 RCT 23 .…”

Section: Resultsmentioning

confidence: 99%

Age and Surgical Complexity impact on Renoprotection by Remote Ischemic Preconditioning during Adult Cardiac Surgery: A Meta analysis

Zhou

Bulluck

Fang

et al. 2017

Sci Rep

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We aimed to conduct an up-to-date meta-analysis to comprehensively assess the renoprotective effect of remote ischemic preconditioning (RIPC) in patients undergoing adult cardiac surgery. 21 randomized controlled trials (RCTs) with a total of 6302 patients were selected and identified. Compared with controls, RIPC significantly reduced the incidence of acute kidney injury (AKI) [odds ratio (OR) = 0.79; P = 0.02; I2 = 38%], and in particular, AKI stage I (OR = 0.65; P = 0.01; I2 = 55%). RIPC significantly shortened mechanical ventilation (MV) duration [weighted mean difference (WMD) = −0.79 hours; P = 0.002; I2 = 53%), and reduced intensive care unit (ICU) stay (WMD = −0.23 days; P = 0.07; I2 = 96%). Univariate meta-regression analyses showed that the major sources of heterogeneity for AKI stage I were age (coefficient = 0.06; P = 0.01; adjusted R2 = 0.86) and proportion of complex surgery (coefficient = 0.02; P = 0.03; adjusted R2 = 0.81). Subsequent multivariate regression and subgroup analyses also confirmed these results. The present meta-analysis suggests that RIPC reduces the incidence of AKI in adults undergoing cardiac surgery and this benefit was more pronounced in younger patients undergoing non-complex cardiac surgery. RIPC may also shorten MV duration and ICU stay. Future RCTs tailored for those most likely to benefit from RIPC warrants further investigation.

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Section: Resultsmentioning

confidence: 99%

Age and Surgical Complexity impact on Renoprotection by Remote Ischemic Preconditioning during Adult Cardiac Surgery: A Meta analysis

Zhou

Bulluck

Fang

et al. 2017

Sci Rep

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“…148 However, one study with increased infarct size also found increased need for postoperative inotropic support and increased ventilation time 128 (Table 3). Also, in adult cardiac valve surgery [150][151][152][153][154][155] and in pediatric cardiac surgery, 103,[156][157][158][159][160][161] most studies found reduced infarct size, as reflected by reduced biomarker release ( Figure 3). The need for inotropic support was reduced in some studies.…”

Section: Remote Ischemic Conditioningmentioning

confidence: 99%

“…The need for inotropic support was reduced in some studies. 103,154,156 Almost all studies that reported their anesthetic regime and did not observe reduced infarct size had used propofol in one or the other regime ( Figure 3). In fact, propofol-in contrast to isoflurane-has been demonstrated to specifically abrogate the protection by remote ischemic preconditioning, 162 and this finding has been confirmed by further studies 153,163 and by a meta-analysis.…”

Section: Remote Ischemic Conditioningmentioning

confidence: 99%

Time to Give Up on Cardioprotection?

Heusch

Rassaf

2016

Circulation Research

174

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Abstract:The mortality from acute myocardial infarction (AMI) remains significant, and the prevalence of postmyocardial infarction heart failure is increasing. Therefore, cardioprotection beyond timely reperfusion is needed. Conditioning procedures are the most powerful cardioprotective interventions in animal experiments. However, ischemic preconditioning cannot be used to reduce infarct size in patients with AMI because its occurrence is not predictable; several studies in patients undergoing surgical coronary revascularization report reduced release of creatine kinase and troponin. Ischemic postconditioning reduces infarct size in most, but not all, studies in patients undergoing interventional reperfusion of AMI, but may require direct stenting and exclusion of patients with >6 hours of symptom onset to protect. Remote ischemic conditioning reduces infarct size in patients undergoing interventional reperfusion of AMI, elective percutaneous or surgical coronary revascularization, and other cardiovascular surgery in many, but not in all, studies. Adequate dose-finding phase II studies do not exist. There are only 2 phase III trials, both on remote ischemic conditioning in patients undergoing cardiovascular surgery, both with neutral results in terms of infarct size and clinical outcome, but also both with major problems in trial design. We discuss the difficulties in translation of cardioprotection from animal experiments and proof-ofconcept trials to clinical practice. Given that most studies on ischemic postconditioning and all studies on remote ischemic preconditioning in patients with AMI reported reduced infarct size, it would be premature to give up on cardioprotection. (Circ Res. 2016;119:676-695.

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“…For the primary endpoints, the incidence of AKI was reported in 14 trails. 20–25,28–30,32–36 In this part, the multicenter randomized study by Meybohm et al 27 was not analyzed, because the patient of AKI grade 1 were not recorded according their supplementary materials. The incidence of renal-replacement therapy was reported in 9 trails.…”

Section: Resultsmentioning

confidence: 99%

“…41 In addition to experimental evidence, several clinical trials have suggested the potential protection of RIPC on reducing kidney damage in humans, 20,36 while some studies found the contrary. 25,29 Lack of knowledge of RIPC and conflicting results of small sample sizes trials 20,21,30,33 may explain the absence of RIPC in the operating room. The inconsistent outcomes across RIPC trials might also have been due to differences in study protocols, different patient populations, comorbid diseases, anesthetic regimens, and surgical technique.…”

Section: Discussionmentioning

confidence: 99%

Remote Ischemic Preconditioning for Prevention of Acute Kidney Injury in Patients Undergoing On-Pump Cardiac Surgery

Zhang

Chi

et al. 2016

Medicine

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Remote ischemic preconditioning (RIPC) may attenuate acute kidney injury (AKI). However, results of studies evaluating the effect of RIPC on AKI after cardiac surgery have been controversial and contradictory.The aim of this meta-analysis is to examine the association between RIPC and AKI after on-pump cardiac surgery.The authors searched relevant studies in PubMed, EMBASE, and the Cochrane Library through December 2015.We considered for inclusion all randomized controlled trials that the role of RIPC in reducing AKI and renal replacement therapy (RRT) among patients underwent on-pump cardiac surgical procedures.We collected the data on AKI, initiation of RRT, serum creatinine (sCr) levels, and in-hospital mortality. Random- and fixed-effect models were used for pooling data.Nineteen trials including 5100 patients were included. The results of this meta-analysis showed a significant benefit of RIPC for reducing the incidence of AKI after cardiac interventions (odds ratio [OR] = 0.84; 95% confidence interval [CI], 0.73–0.98; P = 0.02). No significant difference was found in the incidence of RRT between RIPC and control (OR, 0.76, 95% CI, 0.46–1.24; P = 0.36). In addition, compared with standard medical care, RIPC showed no significant difference in postoperative sCr (IV 0.07; 95% CI, −0.03 to 0.16; P = 0.20; postoperative day 1; IV 0.00; 95% CI, −0.08 to 0.09; P = 0.92; postoperative day 2; IV 0.04; 95% CI, −0.05 to 0.12; P = 0.39; postoperative day 3), and in-hospital mortality (OR, 1.21, 95% CI, 0.64–2.30; P = 0.56).According to the results from present meta-analysis, RIPC was associated with a significant reduction AKI after on-pump cardiac surgery but incidence of RRT, postoperative sCr, and in-hospital mortality. Further high-quality randomized controlled trials and experimental researches comparing RIPC are desirable.

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Multiorgan protection of remote ischemic perconditioning in valve replacement surgery

Cited by 35 publications

References 26 publications

Age and Surgical Complexity impact on Renoprotection by Remote Ischemic Preconditioning during Adult Cardiac Surgery: A Meta analysis

Age and Surgical Complexity impact on Renoprotection by Remote Ischemic Preconditioning during Adult Cardiac Surgery: A Meta analysis

Time to Give Up on Cardioprotection?

Remote Ischemic Preconditioning for Prevention of Acute Kidney Injury in Patients Undergoing On-Pump Cardiac Surgery

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