Clinical benefits of aortic cross-clamping versus limb remote ischemic preconditioning in coronary artery bypass grafting with cardiopulmonary bypass: a meta-analysis of randomized controlled trials

Deng, Qiwen; Xia, Zhi-Qiu; Qiu, Yuxin; Wu, Yan; Liu, Jiaxin; Li, Cai; Liu, Ke-Xuan

doi:10.1016/j.jss.2014.10.007

Cited by 18 publications

(13 citation statements)

References 48 publications

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“…However, most of the related studies investigating RIPC and CABG focus on plasma biomarkers of organ damage, such as cardiac troponin, creatine kinase, and creatine kinase‐myocardial band isoenzyme, rather than on clinical outcomes . A recent meta‐analysis of 29 randomized controlled trials (RCTs) did assess whether aortic cross‐clamping or limb RIPC improved postoperative outcomes of CABG . However, this meta‐analysis included RCTs in which patients underwent various surgical procedures in addition to CABG .…”

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confidence: 99%

Remote Ischemic Preconditioning and Clinical Outcomes in On‐Pump Coronary Artery Bypass Grafting: A Meta‐Analysis of 14 Randomized Controlled Trials

Wang

et al. 2017

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The purpose of this article is to perform the first pooled analysis on remote ischemic preconditioning (RIPC) used for the improvement of clinical outcomes of patients only undergoing on-pump coronary artery bypass grafting (CABG) in randomized controlled trials (RCTs). A systematic search was performed using PubMed, the Cochrane Library, and the Web of Science to identify studies that described the effect of RIPC on postoperative mortality in patients only undergoing on-pump CABG. The outcomes included postoperative mortality, postoperative morbidity (including incidence of myocardial infarction, atrial fibrillation, stroke, acute kidney injury, and renal replacement therapy), mechanical ventilation (MV), intensive care unit length of stay (ICU LOS), and hospital length of stay (HLOS). A total of 14 RCTs (2830 participants) were included. Our meta-analysis found that RIPC failed to reduce the postoperative mortality in patients only undergoing on-pump CABG compared with control individuals (odds ratio, 0.81; 95% confidence interval, [0.40, 1.64]; P = 0.55; I = 25%). Moreover, there were no differences in postoperative morbidity, ICU LOS, and HLOS between the two groups. However, MV in the RIPC group was shorter than that in control individuals (standard mean difference, -0.41; 95% confidence interval, [-0.80, -0.01]; P = 0.04; I = 73%). The present meta-analysis found that RIPC failed to improve most of clinical outcomes in patients only undergoing on-pump CABG; however, MV was reduced. Adequately powered trials are warranted to provide more evidence in the future.

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confidence: 99%

Remote Ischemic Preconditioning and Clinical Outcomes in On‐Pump Coronary Artery Bypass Grafting: A Meta‐Analysis of 14 Randomized Controlled Trials

Wang

et al. 2017

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“…The effect of local ischemic conditioning on thromboembolic risk was investigated in one RCT, in which postconditioning after PCI did not reduce recurrent MI or stent thrombosis. 40 Correspondingly, local ischemic postconditioning did not reduce the incidence of reinfarction or stent thrombosis in two meta-analyses of PCI in ST-elevation MI patients, 87,88 and local ischemic preconditioning failed to reduce the incidence of stroke 89 or MI 90 after coronary artery bypass grafting in two meta-analyses. 89,90 Local ischemic conditioning did not increase intraor postoperative bleeding in seven RCTs 30,32-37 and two case-control studies.…”

Section: Discussionmentioning

confidence: 97%

“…40 Correspondingly, local ischemic postconditioning did not reduce the incidence of reinfarction or stent thrombosis in two meta-analyses of PCI in ST-elevation MI patients, 87,88 and local ischemic preconditioning failed to reduce the incidence of stroke 89 or MI 90 after coronary artery bypass grafting in two meta-analyses. 89,90 Local ischemic conditioning did not increase intraor postoperative bleeding in seven RCTs 30,32-37 and two case-control studies. 10,31 In fact, local ischemic preconditioning before liver resection significantly reduced intraoperative bleeding in one RCT 35 and one meta-analysis.…”

Section: Discussionmentioning

confidence: 97%

“…One meta-analysis compared local ischemic conditioning by aortic cross-clamping to limb remote ischemic preconditioning in coronary artery bypass grafting, and showed no difference in the incidence of MI between the two interventions. 89 Remote ischemic conditioning influenced laboratory parameters of hemostasis in study participants with no ischemic event close to the intervention. 21,22,25,26,78,79 Hence, the intervention could modulate hemostasis by directly affecting platelets or the fibrinolytic system without a preceding ischemic event.…”

Section: Discussionmentioning

confidence: 99%

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Ischemic Conditioning as a Hemostatic Intervention in Surgery and Cardiac Procedures: A Systematic Review

Krag

Hvas

2017

Semin Thromb Hemost

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Ischemic conditioning induced by nonlethal cycles of tissue ischemia and reperfusion attenuates ischemia–reperfusion injury. The objective of this study is to systematically review the effects of local and remote ischemic conditioning on laboratory parameters of hemostasis and the clinical outcomes of thromboembolism or bleeding in patients undergoing surgery or cardiac procedures. PubMed and Embase were searched for relevant human trials published in English between January 1, 1986, and September 7, 2016, and additional studies were identified from reference lists. Data on laboratory parameters of hemostasis, thromboembolism, and bleeding were extracted for qualitative synthesis. In total, 69 studies were included; of these, 53 were randomized controlled trials (RCTs) and 11 were meta-analyses. Local and remote ischemic conditioning reduced platelet activation in patients undergoing cardiac procedures. Local ischemic conditioning did not reduce the thromboembolic risk in patients undergoing surgery or cardiac procedures. Remote ischemic conditioning reduced the incidence of arterial thromboembolism after surgery or cardiac procedures in 3 out of 28 RCTs and 4 out of 5 meta-analyses. Local and remote ischemic conditioning did not increase operative bleeding. In conclusion, ischemic conditioning reduced platelet activity without increasing the risk of bleeding in patients undergoing surgery or cardiac procedures. Limited evidence supports the proposal that ischemic conditioning reduces the incidence of arterial thromboembolism in patients undergoing surgery or cardiac procedures.

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“…Moreover, skeletal muscles are comparatively more resistant to ischemia-reperfusion injury [31] in comparison to other highly perfused organs including intestine and kidney. RIPC stimulus tends to reduce cardiac injury in the patients undergoing various surgical interventions including valve replacement [32], coronary angioplasty [33], coronary artery bypass grafting [34]. Furthermore, RIPC has the capability to reduce kidney injury in patients undergoing cardiac surgeries [35].…”

Section: Clinical Implications Of Ripcmentioning

confidence: 99%

Neurogenic pathways in remote ischemic preconditioning induced cardioprotection: Evidences and possible mechanisms

AmritpalSinghAulakh

PuneetKaurRhawa

NirmalSingh

et al. 2017

Korean J Physiol Pharmacol

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Remote ischemic preconditioning (RIPC) is an intrinsic phenomenon whereby 3~4 consecutive ischemia-reperfusion cycles to a remote tissue (noncardiac) increases the tolerance of the myocardium to sustained ischemiareperfusion induced injury. Remote ischemic preconditioning induces the local release of chemical mediators which activate the sensory nerve endings to convey signals to the brain. The latter consequently stimulates the efferent nerve endings innervating the myocardium to induce cardioprotection. Indeed, RIPC-induced cardioprotective effects are reliant on the presence of intact neuronal pathways, which has been confirmed using nerve resection of nerves including femoral nerve, vagus nerve, and sciatic nerve. The involvement of neurogenic signaling has been further substantiated using various pharmacological modulators including hexamethonium and trimetaphan. The present review focuses on the potential involvement of neurogenic pathways in mediating remote ischemic preconditioning-induced cardioprotection.

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Clinical benefits of aortic cross-clamping versus limb remote ischemic preconditioning in coronary artery bypass grafting with cardiopulmonary bypass: a meta-analysis of randomized controlled trials

Cited by 18 publications

References 48 publications

Remote Ischemic Preconditioning and Clinical Outcomes in On‐Pump Coronary Artery Bypass Grafting: A Meta‐Analysis of 14 Randomized Controlled Trials

Remote Ischemic Preconditioning and Clinical Outcomes in On‐Pump Coronary Artery Bypass Grafting: A Meta‐Analysis of 14 Randomized Controlled Trials

Ischemic Conditioning as a Hemostatic Intervention in Surgery and Cardiac Procedures: A Systematic Review

Neurogenic pathways in remote ischemic preconditioning induced cardioprotection: Evidences and possible mechanisms

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