Remote Ischemic Preconditioning Applied during Isoflurane Inhalation Provides No Benefit to the Myocardium of Patients Undergoing On-pump Coronary Artery Bypass Graft Surgery

Lucchinetti, Eliana; Bestmann, Lukas; Feng, Jianhua; Freidank, Heike; Clanachan, Alexander S.; Finegan, Barry A.; Zaugg, Michael

doi:10.1097/aln.0b013e318242349a

Cited by 128 publications

(93 citation statements)

References 45 publications

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“…Only 2 studies, one of them with only 4 patients per group, reported an increased infarct size with remote ischemic preconditioning. 127,128 Other studies were either neutral 36,38,[129][130][131][132][133][134][135][136][137][138] or had significantly reduced infarct size, as reflected by reduced biomarker release 37,139-149 ( Figure 3). Only one study each found improved clinical outcome at short-term 149 or more long-term follow-up.…”

Section: Remote Ischemic Conditioningmentioning

confidence: 99%

“…Propofol is known to abrogate protection by remote ischemic conditioning, which is seen with volatile anesthesia, 153,[162][163][164] and volatile anesthesia is the recommended anesthesia for patients at cardiac risk. 233,234 As seen from Figure 3, the only study with a significant increase of infarct size 128 and all neutral studies where information on the anesthetic regime is available 36,38,[130][131][132][133][135][136][137][138]150,155 had used propofol anesthesia, which, therefore, appears as the major denominator of all neutral/negative studies on remote ischemic conditioning in cardiovascular surgery.…”

Section: Current State Of Translation For Remote Ischemic Conditioningmentioning

confidence: 99%

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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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Section: Remote Ischemic Conditioningmentioning

confidence: 99%

Section: Current State Of Translation For Remote Ischemic Conditioningmentioning

confidence: 99%

Time to Give Up on Cardioprotection?

Heusch

Rassaf

2016

Circulation Research

174

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“…Omitting the 4 studies using another protocol than the mainly used 3×5-min remote conditioning protocol from analysis, barely affected the heterogeneity (I 2 =68%, P=0.0009), and changed the pooled SMD in favor of RIC (-0.46, 95% CI: -0.76 to -0.16) in the Characteristic a Kottenberg et al 24 Lucchinetti et al 25 Hong et al 26 Target Figure 4B). 6,7,17,20,21, 23 Sensitivity analysis showed that the omission of each study one at a time did not appreciably change the pooled SMD, and the estimates in each case were within the CI of the pooled estimate ( Figure 5).…”

Section: Cabgmentioning

confidence: 99%

Remote Ischemic Conditioning in Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting

Yetgin

Manintveld

Boersma

et al. 2012

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp oronary heart disease (CHD) is the leading cause of death and disability worldwide and one of its major pathophysiological manifestations is acute myocardial infarction (AMI). Although percutaneous coronary intervention (PCI) remains the most effective treatment strategy in patients presenting with AMI, high-risk patients with severe CHD are being referred for coronary artery bypass grafting (CABG). With both forms of treatment, patients are subjected to acute ischemia-reperfusion injury (IRI) and despite the merits of PCI and CABG, mortality and morbidity in these patients remain significant. Thus, cardioprotective strategies further limiting IRI are of major clinical interest in these settings.Remote ischemic conditioning (RIC) represents a novel treatment strategy for limiting myocardial IRI by applying intermittent, sublethal episodes of ischemia and reperfusion to an organ or tissue distant from the heart. Experiments in a canine model by Przyklenk et al first demonstrated that brief ischemic episodes (4 times for 5 min followed by 5 min of reperfusion) of the left circumflex coronary artery significantly reduced myocardial infarct size following sustained occlusion of the left anterior descending coronary artery, that is, remote intracardiac conditioning.

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“…Согласно их данным [23] прекондиционирование не ока-зывает нейропротекторного эффекта. У пациентов с КШ канад-ские анестезиологи оценивали повреждение ГМ по уровню в плазме крови белка S-100 [24]. ДП воспроизводили с помощью 4 циклов ишемии (5 мин) и реперфузии (5 мин) нижней конечно-сти после наркоза изофлураном перед КШ.…”

Section: контактная информацияunclassified

“…Оказалось, что ДИП не влияет на уровень S-100 в крови. Авторы заключили, что ДИП не оказывает нейропротекторного эффекта у больных с КШ [24]. В исследование, выполненное в России, были включены 88 па-циентов, которым выполнялось КШ в условиях ИК [25].…”

Section: контактная информацияunclassified

Neuroprotective and nephroprotective effects of remote postconditioning: Prospects for clinical use

Maslov

Tsibulnikov

Цепокина

et al. 2016

Terapevticheskii arkhiv

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1 фГБну «нИИ кардиологии», Томск, россия; 2 национальный исследовательский Томский политехнический университет, Томск, россия; 3 фГБну нИИ комплексных проблем сердечно-сосудистых заболеваний, Кемерово, россия; 4 республиканский научно-прак-тический центр «Кардиология», Минск, Беларусь Аннотация результаты экспериментальных и клинических исследований убедительно свидетельствуют, что дистантное ишемическое прекондиционирование (ДИП) не оказывает нейропротекторного эффекта при кардиохирургических вмешательствах, выполняемых в условиях искусственного кровообращения. Дистантное прекондиционирование (ДК) не оказывает нейро-протекторного эффекта при геморрагическом инсульте. необходимо проведение рандомизированного многоцентрового исследования для оценки эффективности ДИП у пациентов с ишемическим инсультом. ДК снижает выраженность ишеми-ческого и реперфузионного повреждения почки при трансплантации. установлено, что ДИП предупреждает появление нефропатии, индуцированной контрастным веществом. необходимо многоцентровое исследование для оценки эффек-тивности ДИП у пациентов с протезированием аневризмы брюшной аорты. Анализ представленных данных свидетель-ствует, что ДИП не предупреждает возникновение кардиоренального синдрома у новорожденных и детей при выполнении кардиохирургических вмешательств. Данные литературы о способности ДИП оказывать нефропротекторный эффект у пациентов с коронарным шунтированием носят противоречивый характер и свидетельствуют о целесообразности про-ведения многоцентрового исследования. The results of experimental and clinical studies strongly suggest that remote ischemic preconditioning (rIP) has no neuroprotective effect during cardiac surgery performed under extracorporeal circulation. remote preconditioning (rP) has no neuroprotective effect in hemorrhagic stroke. A randomized multicenter study is needed to evaluate the efficiency rIP in patients with ischemic stroke. rP reduces the severity of ischemia/reperfusion kidney injury during transplantation. rIP has been established to prevent contrast-induced nephropathy. There is a need for a multicenter trial to evaluate the efficiency of rIP in patients with abdominal aortic aneurysm repair. Analysis of the presented data indicates that rIP fails to prevent cardiorenal syndrome in infants and children during cardiac surgery. The data available in the literature on the capacity of rIP to provide nephroprotective effect in patients after coronary artery bypass surgery are discordant and indicative of the advisability of a multicenter study. Keywords: remote ischemic preconditioning, brain, kidneys.Дистантное ишемическое прекондиционирование (ДИП) -это феномен повышения устойчивости к длительной ишемии и реперфузии одного органа после кратковременной ишемии-ре-перфузии другого органа. Полагают, что кратковременная ише-мия и реперфузия вызывают выброс в кровоток гуморального фактора(ов), которые повышают толерантность органов и тканей к ишемии и реперфузии [1][2][3][4][5][6][7]. Предполагают, что подобными факторами могут быть эндогенные каннабин...

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Remote Ischemic Preconditioning Applied during Isoflurane Inhalation Provides No Benefit to the Myocardium of Patients Undergoing On-pump Coronary Artery Bypass Graft Surgery

Abstract: RIPC applied during isoflurane inhalation provides no benefit to the myocardium of patients undergoing on-pump coronary artery bypass grafting.

Cited by 128 publications

References 45 publications

Time to Give Up on Cardioprotection?

Time to Give Up on Cardioprotection?

Remote Ischemic Conditioning in Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting

Neuroprotective and nephroprotective effects of remote postconditioning: Prospects for clinical use

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