Remote Ischemic Conditioning in Cardiovascular Surgery

Heusch, Gerd

doi:10.1177/1074248416687874

Cited by 23 publications

(18 citation statements)

References 37 publications

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“…Anesthesia is a confounder of cardioprotection by RIPC [85]. A meta-analysis by Zangrillo and colleagues reported that volatile anesthesia combined with RIPC reduced the post-operative mortality rate in patients undergoing cardiac surgery [86].…”

Section: Discussionmentioning

confidence: 99%

Remote Ischemic Preconditioning Induces Cardioprotective Autophagy and Signals through the IL-6-Dependent JAK-STAT Pathway

Billah

Ridiandries

Allahwala

et al. 2020

IJMS

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Autophagy is a cellular process by which mammalian cells degrade and assist in recycling damaged organelles and proteins. This study aimed to ascertain the role of autophagy in remote ischemic preconditioning (RIPC)-induced cardioprotection. Sprague Dawley rats were subjected to RIPC at the hindlimb followed by a 30-min transient blockade of the left coronary artery to simulate ischemia reperfusion (I/R) injury. Hindlimb muscle and the heart were excised 24 h post reperfusion. RIPC prior to I/R upregulated autophagy in the rat heart at 24 h post reperfusion. In vitro, autophagy inhibition or stimulation prior to RIPC, respectively, either ameliorated or stimulated the cardioprotective effect, measured as improved cell viability to mimic the preconditioning effect. Recombinant interleukin-6 (IL-6) treatment prior to I/R increased in vitro autophagy in a dose-dependent manner, activating the Janus kinase/signal transducers and activators of transcription (JAK-STAT) pathway without affecting the other kinase pathways, such as p38 mitogen-activated protein kinases (MAPK), and glycogen synthase kinase 3 Beta (GSK-3β) pathways. Prior to I/R, in vitro inhibition of the JAK-STAT pathway reduced autophagy upregulation despite recombinant IL-6 pre-treatment. Autophagy is an essential component of RIPC-induced cardioprotection that may upregulate autophagy through an IL-6/JAK-STAT-dependent mechanism, thus identifying a potentially new therapeutic option for the treatment of ischemic heart disease.

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Section: Discussionmentioning

confidence: 99%

Remote Ischemic Preconditioning Induces Cardioprotective Autophagy and Signals through the IL-6-Dependent JAK-STAT Pathway

Billah

Ridiandries

Allahwala

et al. 2020

IJMS

View full text Add to dashboard Cite

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“…Anesthesia is a confounder of cardioprotection by RIPC [205]. Interestingly, propofol anesthesia did not show significant differences in the primary outcome parameters including cardiovascular health, myocardial infarction, coronary revascularization, stroke and post-operative troponin I release in more than 90% of the CABG patients included in ERICCA trial [206].…”

Section: Challenges Of Translating Ripc In Clinical Settingsmentioning

confidence: 99%

“…Co-medication can also act as a confounder of RIPC. CABG patients receive medications such as anti-diabetic medicines, statins, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, morphine, calcium antagonists-which can interfere with the RIPC effect [205]. These medications may facilitate cardioprotection, which may obscure the potential of RIPC-mediated cardioprotection.…”

Section: Challenges Of Translating Ripc In Clinical Settingsmentioning

confidence: 99%

Circulating mediators of remote ischemic preconditioning: search for the missing link between non-lethal ischemia and cardioprotection

et al. 2019

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Acute myocardial infarction (AMI) is one of the leading causes of mortality and morbidity worldwide. There has been an extensive search for cardioprotective therapies to reduce myocardial ischemia-reperfusion (I/R) injury. Remote ischemic preconditioning (RIPC) is a phenomenon that relies on the body's endogenous protective modalities against I/R injury. In RIPC, non-lethal brief I/R of one organ or tissue confers protection against subsequent lethal I/R injury in an organ remote to the briefly ischemic organ or tissue. Initially it was believed to be limited to direct myocardial protection, however it soon became apparent that RIPC applied to other organs such as kidney, liver, intestine, skeletal muscle can reduce myocardial infarct size. Intriguing discoveries have been made in extending the concept of RIPC to other organs than the heart. Over the years, the underlying mechanisms of RIPC have been widely sought and discussed. The involvement of blood-borne factors as mediators of RIPC has been suggested by a number of research groups. The main purpose of this review article is to summarize the possible circulating mediators of RIPC, and recent studies to establish the clinical efficacy of these mediators in cardioprotection from lethal I/R injury.

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“…The type of anaesthesia was not standardized, which could interfere with RIPC. A recent meta‐analysis has shown that some types of anaesthesia may protect against ischaemia–reperfusion injury. The standard acute anaesthesia protocol in Denmark at all three participating centres during the study period consisted of a propofol and fentanyl‐based anaesthesia, sometimes supported with sevoflurane, at the discretion of the anaesthetist.…”

Section: Discussionmentioning

confidence: 99%

Randomized clinical trial of remote ischaemic preconditioning versus no preconditioning in the prevention of perioperative myocardial infarction during open surgery for ruptured abdominal aortic aneurysm

et al. 2018

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BackgroundRemote ischaemic preconditioning (RIPC) has been suggested as a means of protecting vital organs from reperfusion injury during major vascular surgery. This study was designed to determine whether RIPC could reduce the incidence of perioperative myocardial infarction (MI) during open surgery for ruptured abdominal aortic aneurysm (AAA). Secondary aims were to see if RIPC could reduce 30‐day mortality, multiple organ failure, acute intestinal ischaemia, acute kidney injury and ischaemic stroke.MethodsThis randomized, non‐blinded clinical trial was undertaken at three vascular surgery centres in Denmark. Patients who had open surgery for ruptured AAA were randomized to intervention with RIPC or control in a 1 : 1 ratio. Postoperative complications and deaths were registered, and ECG and blood samples were obtained daily during the hospital stay.ResultsOf 200 patients randomized, 142 (72 RIPC, 70 controls) were included. There was no difference in rates of perioperative MI between the RIPC and control groups (36 versus 43 per cent respectively), or in rates of organ failure. However, in the per‐protocol analysis 30‐day mortality was significantly reduced in the RIPC group (odds ratio 0·46, 95 per cent c.i. 0·22 to 0·99; P = 0·048).ConclusionRIPC did not reduce the incidence of perioperative MI in patients undergoing open surgery for ruptured AAA. Registration number: NCT00883363 ( http://www.clinicaltrials.gov).

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Remote Ischemic Conditioning in Cardiovascular Surgery

Cited by 23 publications

References 37 publications

Remote Ischemic Preconditioning Induces Cardioprotective Autophagy and Signals through the IL-6-Dependent JAK-STAT Pathway

Remote Ischemic Preconditioning Induces Cardioprotective Autophagy and Signals through the IL-6-Dependent JAK-STAT Pathway

Circulating mediators of remote ischemic preconditioning: search for the missing link between non-lethal ischemia and cardioprotection

Randomized clinical trial of remote ischaemic preconditioning versus no preconditioning in the prevention of perioperative myocardial infarction during open surgery for ruptured abdominal aortic aneurysm

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