Effect of Limb Ischemic Preconditioning on Myocardial Injury in Patients Undergoing Mitral Valve Replacement Surgery  - A Randomized Controlled Trial -

Wu, Qingping; Gui, Ping; Wu, Jing; Ding, Defang; Purusram, Gunsham; Dong, Nianguo; Yao, Shanglong

doi:10.1253/circj.cj-10-1130

Cited by 56 publications

(36 citation statements)

References 25 publications

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“…Subgroup analysis of the studies reporting outcomes of CABG with or without AVR showed results consistent with the general trend (SMD -0.42; 95% CI: -0.70 to -0.13, p = 0.005) and I 2 = 67% [9,[20][21][22][23][24][25][26][27]. Studies concerning isolated valvular surgery did not confirm the protective result of rIPC; however, heterogeneity (I 2 = 94%) was essentially influencing the outcome effect under the random [28][29][30]. Relevant outcomes associated with rIPC were found in patients undergoing pediatric cardiac surgery without heterogeneity (I 2 = 0%) (SMD -1.19; 95% CI: -1.56 to -0.82; p = 0.00001) [30][31][32].…”

Section: Sensitivity Analysismentioning

confidence: 65%

“…Finally, fifteen papers were found to present the best available evidence. These studies pertained to: adult coronary bypass grafting surgery with or without AVR [9,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], adult valvular surgery [28][29][30], and pediatric cardiac surgery [31][32][33]. All the available papers were designed as prospective randomized controlled trials.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

“…The majority of patients were operated on due to coronary artery disease (335 in the rIPC group and 340 in the control group) [9,[20][21][22][23][24][25][26][27]. The analysis of rIPC in pediatric patients undergoing cardiac surgery included 67 patients in the rIPC study groups and 70 in the control groups [31][32][33], whereas 89 and 90 patients were submitted to isolated valvular surgery with or without rIPC, respectively [28][29][30]. All studies were proof-of-concept trials with small sample sizes, and only three included more than 100 patients [20][21][22].…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

“…Secondly, this meta-analysis gathered its evidence from proofof-concept trials, which are, by definition, limited in terms of the number of participants. Funnel plot analysis was employed to find evidence of asymmetry, and four studies were indeed found to lie outside the 95% confidence interval, with one additional study located on its border [20,21,24,28,31] (Fig. 3).…”

Section: Degree Of Biasmentioning

confidence: 99%

“…In order to correct for the high heterogeneity in the whole population, we restricted the analysis to studies lying inside the 95% CI on the funnel plot, excluding five studies [20,21,24,28,31]. This correction changed the heterogeneity from 83% to 0% and the effect was still highly significant (SMD -0.69; 95% CI: -0.86 to -0.51; p = 0.00001).…”

Section: Experimental Cardiovascular and Lung Researchmentioning

confidence: 99%

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Experimental cardiovascular and lung research Remote ischemic preconditioning versus standard myocardial protection in cardiac surgery: ten years of clinical trials. A systematic review and meta-analysis

Marczak¹,

Bańkowski²,

Płonek³

et al. 2013

kitp

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StreszczenieCelem niniejszej metaanalizy jest systematyczny przegląd dowodów obrazujących wpływ odległego hartowania niedokrwiennego (rIPC) na mięsień serca pacjentów poddanych operacjom kardiochirurgicznym. Materiały i metody: Przeglądu literatury dokonano na podstawie pełnotekstowych prac publikowanych w bazach danych Medline, Cochrane itp. Włączono badania kontrolowane z randomizacją, porównujące rIPC oraz standardową ochronę mięśnia serca u pacjentów poddanych zabiegom kardiochirurgicznym, jeżeli raportowały co najmniej jeden z wyników: markery uszkodzenia mięśnia sercowego, pooperacyjne zapotrzebowanie na leki wykazujące dodatni efekt inotropowy, czas hospitalizacji na oddziale intensywnej terapii. 268 EXPERIMENTAL CARDIOVASCULAR AND LUNG RESEARCH SummaryObjectives: To systematically review and assess the existing evidence for the applicability of remote ischemic preconditioning (rIPC) in cardiac surgery. Material and methods: Major biomedical databases: Medline, Cochrane, etc. were searched. All randomized controlled trials (RCTs) comparing rIPC and standard myocardial protection in patients submitted to cardiac surgery were included if they reported at least one of the outcomes of interest: myocardial injury markers, postoperative inotropic support, or length of ICU stay. Results: 991 patients were included in the analysis. rIPC was shown to reduce myocardial injury markers postoperatively by -0.63 SMD [-0.99 to -0.28] and postoperative inotropic requirement by -0.40 SMD [-0.66 to -0.16] in the adult patients submitted to cardiac surgery. There has been significant, yet correctable, heterogeneity of the primary outcome of interest, and the available RCTs were small sample studies. Conclusions: This meta-analysis provides evidence confirming that rIPC has potential benefits with regard to myocardial protection.

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Section: Sensitivity Analysismentioning

confidence: 65%

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

Section: Degree Of Biasmentioning

confidence: 99%

Section: Experimental Cardiovascular and Lung Researchmentioning

confidence: 99%

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Experimental cardiovascular and lung research Remote ischemic preconditioning versus standard myocardial protection in cardiac surgery: ten years of clinical trials. A systematic review and meta-analysis

Marczak¹,

Bańkowski²,

Płonek³

et al. 2013

kitp

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“Conditional Conditioning” in cardiac bypass surgery

Hausenloy

Yellon

2012

Basic Res Cardiol

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Coronary artery bypass graft (CABG) surgery remains the procedure of choice for coronary artery revascularization in patients with multi-vessel coronary artery disease (CAD). For patients undergoing elective isolated CABG surgery, clinical outcomes are very good (1.5 % in-hospital mortality in the UK) [35]. However, increasing numbers of higher risk patients are being operated, resulting in higher in-hospital mortality rates. The reasons for this increase in high risk patients include: patients being older (25 % of all cardiac surgery in the UK is in patients over 75 years of age); the increasing prevalence of co-morbidities such as diabetes (33 % increase since 2001 and in-hospital mortality of 1.9 %), left ventricular impairment (in-hospital mortality is 6.8 % in patients with poor left ventricular systolic function), extra-cardiac arteriopathy (in-hospital mortality of 2.9 %), renal impairment (in-hospital mortality of 8.9 %), previous myocardial infarction (doubles in-hospital mortality) and valvular disease (in-hospital mortality is 3.5 % for valve only surgery and 6

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The remote ischemic preconditioning algorithm: effect of number of cycles, cycle duration and effector organ mass on efficacy of protection

et al. 2016

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Remote ischemic preconditioning (rIPC), induced by cycles of transient limb ischemia and reperfusion (IR), is cardioprotective. The optimal rIPC-algorithm is not established. We investigated the effect of cycle numbers and ischemia duration within each rIPC-cycle and the influence of effector organ mass on the efficacy of cardioprotection. Furthermore, the duration of the early phase of protection by rIPC was investigated. Using a tourniquet tightened at the inguinal level, we subjected C57Bl/6NTac mice to intermittent hind-limb ischemia and reperfusion. The rIPC-protocols consisted of (I) two, four, six or eight cycles, (II) 2, 5 or 10 min of ischemia in each cycle, (III) single or two hind-limb occlusions and (IV) 0.5, 1.5, 2.0 or 2.5 h intervals from rIPC to index cardiac ischemia. All rIPC algorithms were followed by 5 min of reperfusion. The hearts were subsequently exposed to 25 min of global ischemia and 60 min of reperfusion in an ex vivo Langendorff model. Cardioprotection was evaluated by infarct size and post-ischemic hemodynamic recovery. Four to six rIPC cycles yielded significant cardioprotection with no further protection by eight cycles. Ischemic cycles lasting 2 min offered the same protection as cycles of 5 min ischemia, whereas prolonged cycles lasting 10 min abrogated protection. One and two hind-limb preconditioning were equally protective. In our mouse model, the duration of protection by rIPC was 1.5 h. These findings indicate that the number and duration of cycles rather than the tissue mass exposed to rIPC determines the efficacy of rIPC.

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Effect of Limb Ischemic Preconditioning on Myocardial Injury in Patients Undergoing Mitral Valve Replacement Surgery - A Randomized Controlled Trial -

Cited by 56 publications

References 25 publications

Experimental cardiovascular and lung research Remote ischemic preconditioning versus standard myocardial protection in cardiac surgery: ten years of clinical trials. A systematic review and meta-analysis

Experimental cardiovascular and lung research Remote ischemic preconditioning versus standard myocardial protection in cardiac surgery: ten years of clinical trials. A systematic review and meta-analysis

“Conditional Conditioning” in cardiac bypass surgery

The remote ischemic preconditioning algorithm: effect of number of cycles, cycle duration and effector organ mass on efficacy of protection

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