Normothermic retrograde blood cardioplegia with or without preceding ischemic preconditioning

Kaukoranta, Päivi; Lepojärvi, Martti; Ylitalo, Kari; Kiviluoma, Kai; Peuhkurinen, Keijo

doi:10.1016/s0003-4975(97)00100-8

Cited by 71 publications

(32 citation statements)

References 18 publications

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“…There are also a number of studies where an ischemic preconditioning algorithm was used in coronary artery bypass graft or valvular surgery, and protection was seen in terms of reduced release of serum biomarkers (creatine kinase-MB, troponin I or T) (Jenkins et al, 1997;Lu et al, 1997;Szmagala et al, 1998;Li et al, 1999;Teoh et al, 2002a,b;Buyukates et al, 2005;Codispoti et al, 2006;Ji et al, 2007;Amr and Yassin, 2010). However, not all studies were positive (Alkhulaifi et al, 1994;Perrault et al, 1996;Cremer et al, 1997;Kaukoranta et al, 1997;Illes and Swoyer, 1998;Pêgo-Fernandes et al, 2000;Wu et al, 2001;Ghosh and Galinanes, 2003;Jebeli et al, 2010). Both positive and Confounders of Cardioprotection negative studies suffer from small cohort sizes and lack of clinical outcome as endpoint.…”

Section: A Ischemic Preconditioningmentioning

confidence: 99%

Interaction of Risk Factors, Comorbidities, and Comedications with Ischemia/Reperfusion Injury and Cardioprotection by Preconditioning, Postconditioning, and Remote Conditioning

Ferdinándy¹,

Hausenloy²,

Heusch³

et al. 2014

Pharmacological Reviews

516

501

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Section: A Ischemic Preconditioningmentioning

confidence: 99%

Interaction of Risk Factors, Comorbidities, and Comedications with Ischemia/Reperfusion Injury and Cardioprotection by Preconditioning, Postconditioning, and Remote Conditioning

Ferdinándy¹,

Hausenloy²,

Heusch³

et al. 2014

Pharmacological Reviews

516

501

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“…The study cohorts were only small, but most of these studies revealed an infarct size reduction, that is, less injury ( Figure 1). [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] Some of these small studies looked at short-term clinical outcome as secondary end point, and either no effect or a reduction of postoperative arrhythmias, 55,63 need for inotropic support, 49,52,55,59,63 and intensive care unit stay 52 were reported (Table 1). Preinfarction angina may or may not be a correlate of ischemic preconditioning, but because of its nature, only retrospective associative analyses are available.…”

Section: Ischemic Preconditioningmentioning

confidence: 99%

Time to Give Up on Cardioprotection?

Heusch

Rassaf

2016

Circulation Research

176

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Abstract:The mortality from acute myocardial infarction (AMI) remains significant, and the prevalence of postmyocardial infarction heart failure is increasing. Therefore, cardioprotection beyond timely reperfusion is needed. Conditioning procedures are the most powerful cardioprotective interventions in animal experiments. However, ischemic preconditioning cannot be used to reduce infarct size in patients with AMI because its occurrence is not predictable; several studies in patients undergoing surgical coronary revascularization report reduced release of creatine kinase and troponin. Ischemic postconditioning reduces infarct size in most, but not all, studies in patients undergoing interventional reperfusion of AMI, but may require direct stenting and exclusion of patients with >6 hours of symptom onset to protect. Remote ischemic conditioning reduces infarct size in patients undergoing interventional reperfusion of AMI, elective percutaneous or surgical coronary revascularization, and other cardiovascular surgery in many, but not in all, studies. Adequate dose-finding phase II studies do not exist. There are only 2 phase III trials, both on remote ischemic conditioning in patients undergoing cardiovascular surgery, both with neutral results in terms of infarct size and clinical outcome, but also both with major problems in trial design. We discuss the difficulties in translation of cardioprotection from animal experiments and proof-ofconcept trials to clinical practice. Given that most studies on ischemic postconditioning and all studies on remote ischemic preconditioning in patients with AMI reported reduced infarct size, it would be premature to give up on cardioprotection. (Circ Res. 2016;119:676-695.

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“…59 Similarly negative results have been reported by another group. 60 These divergent results have led to the hypothesis that in the setting of coronary artery bypass surgery, the additional protection conferred by ischemic preconditioning may only be demonstrable in cases in which a potential for suboptimal myocardial protection increases the risk of perioperative infarction. 61 However, this hypothesis is not supported by recent studies that indicate improved myocardial preservation by ischemic preconditioning during coronary bypass or valve surgery despite optimal protection with hypothermia and cardioplegia.…”

Section: Does Preconditioning Occur In the Human Heart?mentioning

confidence: 99%

The Preconditioning Phenomenon

Yellon

Dana

2000

Circulation Research

118

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Abstract-The possibility that an innate mechanism of myocardial protection might be inducible in the human heart has generated considerable excitement and enthusiastic research. The potential to enhance myocardial resistance to ischemic injury in patients suffering the consequences of coronary artery disease has led to studies with more direct clinical relevance. However, in common with many other areas of clinical interest based on advances in basic scientific understanding, early enthusiasm may be disproportionate to ultimate therapeutic significance. There can be little doubt that our understanding of the mechanisms underlying the pathogenesis of ischemia-reperfusion injury has been enhanced significantly by the plethora of research stimulated by interest in endogenous myocardial protection. Direct extrapolation of observations in the laboratory to the cardiology clinic or operating theater is tempting but should be avoided. The results of recent clinical experiments that suggest that preconditioning can protect against ischemia, although encouraging, should be interpreted cautiously, with particular attention to the limitations of the end points available. A reasoned evaluation of recent research should prevent unrealistic expectations and allow improved design of future trials so that this potent adaptive phenomenon can be exploited to its maximum potential. (Circ Res. 2000;87:543-550.)

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Normothermic retrograde blood cardioplegia with or without preceding ischemic preconditioning

Cited by 71 publications

References 18 publications

Interaction of Risk Factors, Comorbidities, and Comedications with Ischemia/Reperfusion Injury and Cardioprotection by Preconditioning, Postconditioning, and Remote Conditioning

Interaction of Risk Factors, Comorbidities, and Comedications with Ischemia/Reperfusion Injury and Cardioprotection by Preconditioning, Postconditioning, and Remote Conditioning

Time to Give Up on Cardioprotection?

The Preconditioning Phenomenon

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