ObjectiveThis study was carried out to assess whether the remote ischemic preconditioning (RIPC) affects the inflammatory response in patients undergoing the aortic valve replacement. Methods Twenty seven patients were included into the prospective randomised study. In all cases the aortic valve replacement was performed due to the aortic stenosis under cardiopulmonary bypass (CPB). 13 patients of main group received RIPC and 14 patients formed control group. Anaesthesia was maintained either by propofol and fentanyl (7 patients in the control group, 8 patients in the RIPC group) or by sevoflurane and fentanyl (7 patients in the control group, 5 patients in the RIPC group). RIPC was induced by three 5-min cycles of lower limb ischemia and reperfusion after anaesthesia induction. Cytokines (interleukin-8 (IL-8), interleukin-6 (IL-6)) were analysed at baseline, 30 min, 12 h, 24 h and 48 h after CPB completion. Quantitative data were presented as median (25th–75th percentile). According to nonparametrically distribution, data were assessed by the Mann-Whitney U-test, a P value < 0.05 was considered as significant. Results Our study displayed the significant increase in cytokines levels after CPB completion in both groups. There were no statistical differences in IL-8 and IL-6 concentrations between groups at 30 min and 12 h after CPB. Unexpectedly we found the significantly higher IL-8 activity in the RIPC group at 24 h and 48 h after CPB: it was 12.3 (7.9; 16.5) pg/mL vs. 6.5 (5.5; 10.4) pg/mL in the control group, p = 0.03 at 24 h and 10.6 (5.8; 13.2) pg/mL vs. 5.5 (4.5; 6.1) pg/mL in the control group, p = 0.02 at 48 h. The same tendency was found in IL-6 activity, however statistical significance between the RIPC group and the control one was not confirmed: 27.6 (15.1; 38.5) pg/mL vs. 15.3 (10.5; 28.8) pg/mL, respectively (p = 0.32) at 24 h and 17.1 (13.0; 27.3) pg/mL vs. 9.9 (6.8; 17.2) pg/mL, respectively (p = 0.14) at 48 h. Conclusions This pilot study indicates surprisingly that RIPC may enhance inflammatory response after CPB. Our data suggest that large clinical trials assessing the effects of RIPC on the inflammatory response should be performed in order to study the underlying mechanisms.

ObjectiveThe present study was carried out to estimate whether the remote ischemic preconditioning (RIPC) reduces myocardial injury in the patients undergoing aortic valve replacement (AoVR) Methods 27 patients were included into the prospective randomised study. In all cases the AoVR was performed due to the aortic stenosis under cardiopulmonary bypass (CPB). 13 patients of the main group received RIPC and 14 patients formed the control group. Anaesthesia was maintained either by propofol and fentanyl (7 patients in the control group, 8 patients in the RIPC group) or by sevoflurane and fentanyl (7 patients in the control group, 5 patients in the RIPC group). RIPC was induced by three 5-min cycles of lower limb ischemia and reperfusion. Troponin I (cTnI) was analysed at baseline, 30 min, 12, 24, 48 h after CPB completion. Quantitative data were presented as median (25th–75th percentile). According to nonparametrically distribution, data were assessed by the Mann-Whitney U-test. Results We found significant elevation in cTnI levels above baseline in both groups with maximal values at 12 h for control group and at 24 h for RIPC group. There was no statistical difference in cTnI levels between groups at 12 h (2.7 (1.7; 3.8) ng/ml for RIPC group vs. 2.9 (1.5; 6.9) ng/ml for the control group, p = 0.70) and at 24 h (2.4 (1.6; 3.1) ng/ml vs. 3.5 (1.7; 6.9) ng/ml respectively, p = 0.45). The area under the curve (AUC) for cTnI for the RIPC group was equal 122.2 (72.1; 127.4) ng/ml/48 h and did not differ significantly compared with the control group (144.8 (79.8; 251.5) ng/ml/48 h), p = 0.35. Significant differences in the cTnI levels between the RIPC group and the control one were found only when sevoflurane anaesthesia cases were selected for analysis: those levels were 1.6 (1.5; 2.2) ng/ml vs. 5.5 (4.0; 6.5) ng/ml respectively (p = 0.03) at 24 h and 1.4 (1.3; 1.5) ng/ml vs. 3.2 (2.9; 3.6) ng/ml (p = 0.02) at 48 h. Moreover, in the sevoflurane subgroup the statistical difference was displayed for cTnI AUC: 69.0 (65.8; 97.5) ng/ml/48 h in the RIPC group vs. 250.9 (250.4; 296.6) ng/ml/48 h in the control group, p = 0.02. There were no statistical differences in the cTnI levels and the cTnI AUC between the RIPC group and the control one in the propofol anaesthesia cases. Conclusions The data from this pilot study suggest that the cardioprotective effects of RIPC should be evaluated in the selected anaesthesia technique group.

The purpose of our prospective, consistent, non-randomized study was to analyze the results of vasoreactivity tests (VRT) performed with nitric oxide (NO) or inhaled Iloprost in heart transplant candidates. 72 VRTs were done in 58 candidates for heart transplantation. All patients had heart failure III-IV NYHA and pulmonary hypertension (PH) with pulmonary vascular resistance (PVR) over 2.5 WU. 43 patients received NO, 80 ppm for 20 min. 29 patients inhaled 20 g of Iloprost (Ventavis, Bayer). Hemodynamic parameters were measured at baseline, 20 min after NO inhalation and 15 min following the completion of Iloprost inhalation. There were no between-group differences in the severity of patient's condition and baseline hemodynamic indicators. Both vasodilators caused statistically significant reduction in mean PAP: in the NO group it dropped (p = 0.002), in the Iloprost group the mean PAP decreased (p<0.0001). A more than 20% decrease in PAP was recorded in 13 cases (30.2%) in the NO group and in 16 cases (55.2%) in the Iloprost group (p = 0.03). A more than 20% decrease in PVR was noted in 24 cases (55.8%) in the NO group and in 24 cases (82.8%) in the Iloprost group (p<0.02). We found some differences in the effect of NO and Iloprost on LV efficiency. There were no changes in the stroke volume index (SVI) in the NO group, while inhaled Iloprost increased SVI (p<0.001). A probable cause of the increase in LV efficiency might have been the reduction of total peripheral vascular resistance (p<0.0001). There were no differences in SVI during NO inhala-tion. It should be noted in conclusion that Iloprost is more effective in decreasing mean PAP and PVR in heart transplant candidates. Inhaled Iloprost causes favorable changes in preload and afterload of the impaired LV and increases its performance.

Aim – determine a forms of metabolic acidosis (MetAc) after cardiac surgery with cardiopulmonary bypass (CPB). Estimate significance of MetAc in an early postoperative period.Material and methods. We included the 129 adult cardiac surgery patients. We studied the indicators of acid-base blood status, markers of systemic inflammation, an oxygen delivery and consumption, the hemodynamic parameters, the clinical course of the postoperative period.Results. The acid-base disorders were found in 73.6 % of cases. The metabolic acidosis was in 51.2 % of cases: the lactate acidosis was in 92.4 % and the hyperchloremic acidosis was in 7.6 %. The metabolic lactate acidosis was represented by two forms: 1. the acid-base disorders due to a low cardiac output syndrome with a decrease in oxygen delivery and contractility (14.7 %); 2. the lactate acidosis due to a systemic inflammatory response syndrome (49.2 % of cases). It is associated with a high delivery and a low oxygen extraction, increased cardiac output and a vasoplegia. Patients with these disorders had a higher level of leukocytosis after 24 hours of the end the operation, had a longer duration of respiratory support and a long ICU stay and hospital stay.Conclusion. The lactate acidosis is represented by two forms: the lactate acidosis associated with the low cardiac output syndrome and lactate acidosis associated with the systemic inflammatory response. The lactate acidosis is a predictor of adverse outcome after cardiac surgery with CPB and associated with a postoperative complications and a mortality.