The application of remote ischemic conditioning in cardiac surgery

Abstract

Perioperative myocardial ischemia and infarction are the leading causes of morbidity and mortality following anesthesia and surgery. The discovery of endogenous cardioprotective mechanisms has led to testing of new methods to protect the human heart. These approaches have included ischemic pre-conditioning, per-conditioning, post-conditioning, and remote conditioning of the myocardium. Pre-conditioning and per-conditioning include brief and repetitive periods of sub-lethal ischemia before and during prolonged ischemia, respectively; and post-conditioning is applied at the onset of reperfusion. Remote ischemic conditioning involves transient, repetitive, non-lethal ischemia and reperfusion in one organ or tissue (remote from the heart) that renders myocardium more resistant to lethal ischemia/reperfusion injury. In healthy, young hearts, many conditioning maneuvers can significantly increase the resistance of the heart against ischemia/reperfusion injury. The large multicenter clinical trials with ischemic remote conditioning have not been proven successful in cardiac surgery thus far. The lack of clinical success is due to underlying risk factors that interfere with remote ischemic conditioning and the use of cardioprotective agents that have activated the endogenous cardioprotective mechanisms prior to remote ischemic conditioning. Future preclinical research using remote ischemic conditioning will need to be conducted using comorbid models.

Vascular endothelial growth factor regulation of endothelial nitric oxide synthase phosphorylation is involved in isoflurane cardiac preconditioning

“…Perioperative myocardial I/R injury has been identified as the leading cause of morbidity and mortality in cardiac surgery. 1 Reduction of myocardial I/R injury benefits numerous patients receiving cardiac surgery.…”

TRPV1 Contributes to Modulate the Nitric Oxide Pathway and Oxidative Stress in the Isolated and Perfused Rat Heart during Ischemia and Reperfusion

“…In this sense, TRPV1 may importantly participate in cardioprotection. Although its role has been studied in different preconditioning, postconditioning and remote preconditioning models [ 38 , 39 , 40 ], the mechanism of transmission of signals that are involved in cardioprotection have not yet been elucidated. Therefore, in this paper we tested the role of TRPV1 in the possible restoration of cardiac function in ischemia and reperfusion.…”

Comparison of remote and local postconditioning against hepatic ischemic-reperfusion injury in rats

“…This procedure was first described by McClanahan et al . 10 , who verified that renal ischemia and reperfusion cycles created myocardium protection against IRS 11 , 12 .…”