Cardioprotective Effect of Remote Ischemic Preconditioning with Postconditioning on Donor Hearts in Patients Undergoing Heart Transplantation: a single-center, double-blind, randomized controlled trial

Abstract Background Cardioprotective effect of remote ischemic preconditioning (RIPC) in cardiovascular surgery is controversy. This study investigated whether RIPC combined with remote ischemic postconditioning (RIPostC) reduces myocardial injury on donor hearts in patients undergoing heart transplantation. Methods One hundred and twenty patients scheduled for orthotopic heart transplantation were enrolled and randomly assigned to an RIPC+RIPostC group (n=60) or a control (n=60) group. In the RIPC+RIPostC group, four cycles of 5-min ischemia and 5-min reperfusion were applied on the right upper limb by a cuff inflated to 200mmHg after anesthesia induction (RIPC) and 20 minutes after aortic declamping (RIPostC). Serum cardiac troponin I (cTnI) level was determined preoperatively and at 3, 6, 12, 24 h after aortic declamping. Postoperative clinical outcomes were recorded. The primary endpoint was comparison of the cTnI levels at 6 h after aortic declamping. Results Compare with the preoperative baseline, serum cTnI levels peaked at 6h after aortic declamping in two groups. Compare with the control group, RIPC+RIPostC significantly reduced the serum cTnI levels at 6h after aortic declamping (38.87±31.81 vs 69.30±34.13ng/ml, P=0.018). There was no significant difference in in-hospital morbidity and mortality between the two groups. Conclusion In patients undergoing orthotopic heart transplantation, RIPC combined with RIPostC reduced myocardial injury at 6h after aortic declamping,while we found no evidence of this function provided by RIPC+RIPostC could improve clinical outcomes

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Cardioprotective Effect of Remote Ischemic Preconditioning with Postconditioning on Donor Hearts in Patients Undergoing Heart Transplantation: a single-center, double-blind, randomized controlled trial

10.21203/rs.2.182/v1 ◽

2019 ◽

Author(s):

Guyan Wang ◽

Ying Zhang ◽

Lijing Yang ◽

Yimeng Chen ◽

Zhongrong Fang ◽

...

Keyword(s):

Heart Transplantation ◽

Clinical Outcomes ◽

Ischemic Preconditioning ◽

Myocardial Injury ◽

Cardioprotective Effect ◽

Trial Registration ◽

Remote Ischemic Preconditioning ◽

Orthotopic Heart Transplantation ◽

Anesthesia Induction ◽

Significant Difference

Abstract Background: Cardioprotective effect of remote ischemic preconditioning (RIPC) in cardiovascular surgery is controversy. This study investigated whether RIPC combined with remote ischemic postconditioning (RIPostC) reduces myocardial injury on donor hearts in patients undergoing heart transplantation. Methods: One hundred and twenty patients scheduled for orthotopic heart transplantation were enrolled and randomly assigned to an RIPC+RIPostC group (n=60) or a control (n=60) group. In the RIPC+RIPostC group, four cycles of 5-min ischemia and 5-min reperfusion were applied on the right upper limb by a cuff inflated to 200mmHg after anesthesia induction (RIPC) and 20 minutes after aortic declamping (RIPostC). Serum cardiac troponin I (cTnI) level was determined preoperatively and at 3, 6, 12, 24 h after aortic declamping. Postoperative clinical outcomes were recorded. The primary endpoint was comparison of the cTnI levels at 6 h after aortic declamping. Results: Compare with the preoperative baseline, serum cTnI levels peaked at 6h after aortic declamping in two groups. Compare with the control group, RIPC+RIPostC significantly reduced the serum cTnI levels at 6h after aortic declamping (38.87±31.81 vs 69.30±34.13ng/ml, P=0.018). There was no significant difference in in-hospital morbidity and mortality between the two groups. Conclusion: In patients undergoing orthotopic heart transplantation, RIPC combined with RIPostC reduced myocardial injury at 6h after aortic declamping，while we found no evidence of this function provided by RIPC+RIPostC could improve clinical outcomes Trial Registration: Trial Registration Number: chictr.org.cn. no. ChiCTR-INR-16010234. (Prospectively registered). The initial registration date was 9/1/2017. Keywords: Ischemia; preconditioning; postconditioning; heart transplantation

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Cardioprotective effect of remote ischemic preconditioning with postconditioning on donor hearts in patients undergoing heart transplantation: a single-center, double-blind, randomized controlled trial

BMC Anesthesiology ◽

10.1186/s12871-019-0720-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Guyan Wang ◽

Ying Zhang ◽

Lijing Yang ◽

Yimeng Chen ◽

Zhongrong Fang ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Heart Transplantation ◽

Ischemic Preconditioning ◽

Controlled Trial ◽

Cardioprotective Effect ◽

Remote Ischemic Preconditioning ◽

Single Center ◽

Double Blind ◽

Randomized Controlled

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Remote Ischemic Preconditioning Neither Improves Survival nor Reduces Myocardial or Kidney Injury in Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI)

Journal of Clinical Medicine ◽

10.3390/jcm9010160 ◽

2020 ◽

Vol 9 (1) ◽

pp. 160 ◽

Cited By ~ 2

Author(s):

Mandy Flechsig ◽

Tobias F. Ruf ◽

Willi Troeger ◽

Stephan Wiedemann ◽

Silvio Quick ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Ischemic Preconditioning ◽

Myocardial Injury ◽

Kidney Injury ◽

Remote Ischemic Preconditioning ◽

Transcatheter Aortic Valve ◽

Significant Difference ◽

Aortic Valve Implantation ◽

Valve Implantation

Background: Peri-interventional myocardial injury occurs frequently during transcatheter aortic valve implantation (TAVI). We assessed the effect of remote ischemic preconditioning (RIPC) on myocardial injury, acute kidney injury (AKIN) and 6-month mortality in patients undergoing TAVI. Methods: We performed a prospective single-center controlled trial. Sixty-six patients treated with RIPC prior to TAVI were enrolled in the study and were matched to a control group by propensity-score. RIPC was applied to the upper extremity using a conventional tourniquet. Myocardial injury was assessed using high-sensitive troponin-T (hsTnT), and kidney injury was assessed using serum creatinine levels. Data were compared with the Wilcoxon-Rank and McNemar tests. Mortality was analysed with the log-rank test. Results: TAVI led to a significant rise of hsTnT across all patients (p < 0.001). No significant inter-group difference in maximum troponin release or areas-under-the-curve was detected. Medtronic CoreValve and Edwards Sapien valves showed similar peri-interventional troponin kinetics and patients receiving neither valve did benefit from RIPC. AKIN occurred in one RIPC patient and four non-RIPC patients (p = 0.250). No significant difference in 6-month mortality was observed. No adverse events related to RIPC were recorded. Conclusion: Our data do not show a beneficial role of RIPC in TAVI patients for cardio- or renoprotection, or improved survival.

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Pre-operative risk factors and clinical outcomes associated with vasoplegia in recipients of orthotopic heart transplantation in the contemporary era

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2011.10.010 ◽

2012 ◽

Vol 31 (3) ◽

pp. 282-287 ◽

Cited By ~ 50

Author(s):

Maria Patarroyo ◽

Cesar Simbaqueba ◽

Kevin Shrestha ◽

Randall C. Starling ◽

Nicholas Smedira ◽

...

Keyword(s):

Risk Factors ◽

Heart Transplantation ◽

Clinical Outcomes ◽

Operative Risk ◽

Orthotopic Heart Transplantation

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Remote Ischemic Preconditioning Reduces Myocardial Injury in Patients Undergoing Coronary Stent Implantation

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2012.11.022 ◽

2013 ◽

Vol 29 (9) ◽

pp. 1084-1089 ◽

Cited By ~ 56

Author(s):

Sheng Jie Luo ◽

Yu Jie Zhou ◽

Dong Mei Shi ◽

Hai Long Ge ◽

Jian Long Wang ◽

...

Keyword(s):

Ischemic Preconditioning ◽

Stent Implantation ◽

Myocardial Injury ◽

Coronary Stent ◽

Remote Ischemic Preconditioning ◽

Coronary Stent Implantation

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Is there a protective effect with remote ischemic preconditioning on contrast-induced acute renal injury after coronary angiography in low-risk patients?

Journal of Nephropathology ◽

10.15171/jnp.2019.38 ◽

2018 ◽

Vol 8 (4) ◽

pp. 38-38

Author(s):

Sanaz Soleymani ◽

Hamid Reza Samimagham ◽

Mohammad Tamaddondar ◽

Hossein Farshidi ◽

Mahmood Khayatian ◽

...

Keyword(s):

Coronary Angiography ◽

Serum Creatinine ◽

Protective Effect ◽

Ischemic Preconditioning ◽

Low Risk ◽

Remote Ischemic Preconditioning ◽

Control Group ◽

Renal Biomarkers ◽

Significant Difference ◽

Risk Patients

Introduction: Contrast-induced acute kidney injury (CIN-AKI) is a serious complication of coronary angiography. Given the weaknesses in the common protective methods used to prevent CIN-AKI, a safe and effective strategy is needed. RIPC has been shown to have a nephroprotective effect. Objectives: We aimed to determine the protective effect of RIPC on CIN-AKI after angiography or percutaneous coronary intervention (PCI) in low-risk patients. Patients and Methods: In our study, 140 low-risk patients who needed angiography or PCI, were assigned to either RIPC or control group. In each group, serum creatinine and urinary neutrophil gelatinaseassociated lipocalin (uNGAL) were measured before the procedure. Serum creatinine was measured daily for 2 days and uNGAL was measured 6 and 24 hours after the procedure. Diagnosis of AKI was, according to the Kidney Disease; Improving Global Outcomes (KDIGO) criteria (2012). Results: The mean age in the remote ischemic preconditioning (RIPC) group was 56.8 ± 11.4 years and 56.3 ± 11.8 years in the control group. We observed no significant difference regarding patient’s characteristic and renal biomarkers at baseline. There was no significant difference in the incidence of AKI (P = 0.116). The uNGAL increased by 36.2% 6-hour after the procedure in patients with AKI, while at the same time, this biomarker increased only by 4.3% in patients without AKI. Conclusion: We concluded that RIPC, with 3 cycles of 5-minute ischemia and 5-minute reperfusion, did not decrease CIN-AKI or altering renal biomarkers course in low-risk patients undergoing coronary angiography or PCI. Additionally, uNGAL, seems to be an appropriate biomarker for early diagnosis of CIN-AKI, 6 hours after contrast media exposure.

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