Remote Ischemic Preconditioning Reduces Myocardial and Renal Injury After Elective Abdominal Aortic Aneurysm Repair

Ali, Ziad A.; Callaghan, Chris; Lim, Eric; Ali, Ayyaz; Nouraei, S.A.R.; Akthar, Asim M.; Boyle, Jonathan R.; Varty, K.; Kharbanda, Rajesh K.; Dutka, David P.; Gaunt, Michael E.

doi:10.1161/circulationaha.106.679167

Cited by 336 publications

(315 citation statements)

References 42 publications

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“…Remote ischemic preconditioning reduces myocardial injury after major cardiovascular surgery 26 . A trial in patients undergoing abdominal aortic aneurysm repair reported a significant reduction in perioperative myocardial infarctions 27 .…”

Section: Ischemic Pre and Postconditioning In Skeletal Muscle Injury mentioning

confidence: 99%

Ischemic pre and postconditioning in skeletal muscle injury produced by ischemia and reperfusion in rats

Lintz¹,

Dalio²,

Joviliano³

et al. 2013

Acta Cir. Bras.

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PURPOSE:To investigate the protective effects of ischemic pre and postconditioning, as well as the association of both methods, in skeletal muscle injury produced by ischemia and reperfusion in rats. METHODS:An experimental study was designed using 40 Wistar rats divided in four groups (n=10): Control -rats submitted to ischemia for 240 minutes (min) and reperfusion for 60 min; Ischemic preconditioning (Pre) -animals submitted to three cycles of clamping and releasing the aorta for five min before being submitted to the ischemia/reperfusion procedure; Ischemic postconditioning (Post) -rats submitted to three cycles of clamping and releasing the aorta for one min after the 240-minute ischemic phase; Ischemic pre and postconditioning (Pre-post) -animals submitted to the same procedures of Pre and Post groups. Skeletal muscle injury was evaluated by measuring serum levels of aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine phosphokinase (CPK); and muscular levels of malondialdehyde (MDA) and glycogen. RESULTS:AST levels were significantly higher in Pre and Pre-post groups (P<.01). There were no differences in LDH and CPK levels. Muscular MDA levels were similar. Glycogen levels were significantly higher in Pre and Pre-post groups (P<.01). CONCLUSIONS:Both preconditioning and its association with postconditioning had a protective effect by avoiding glycogen depletion in skeletal muscle in rats submitted to ischemia and reperfusion. Association of pre and postconditioning did not show advantage compared to preconditioning alone. Postconditioning alone did not show protective effect.

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Section: Ischemic Pre and Postconditioning In Skeletal Muscle Injury mentioning

confidence: 99%

Ischemic pre and postconditioning in skeletal muscle injury produced by ischemia and reperfusion in rats

Lintz¹,

Dalio²,

Joviliano³

et al. 2013

Acta Cir. Bras.

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“…1,6,7,9,[12][13][14][15][16][17][18] The characteristics of the included studies are shown in Table I. From the 11 included studies, five were prospective.…”

Section: Resultsmentioning

confidence: 99%

“…From the 11 included studies, five were prospective. 1,12,13,15,17 These studies recruited patients from a variety of surgical disciplines, and included both elective and emergency patients.…”

Section: Resultsmentioning

confidence: 99%

“…17 Two studies controlled for all five of the RCRI variables included in the European guidelines for cardiovascular assessment for noncardiac surgery, 7,18 two studies for four risk factors, 6,16 three studies for three of the risk factors, 1,9,12 two studies for two of the risk factors, 13,14 and one study for ischaemic heart disease only. 15 Primary adverse cardiac outcome…”

Section: Control For Preoperative Cardiac Risk Factorsmentioning

confidence: 99%

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A meta-analysis of intraoperative factors associated with postoperative cardiac complications

Skinner

Goga

Rodseth

et al. 2012

Southern African Journal of Anaesthesia and Analgesia

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Original Research: A meta-analysis of intraoperative factors associated with postoperative cardiac complications 186 2012;18(4) South Afr J Anaesth Analg IntroductionA recent study has shown that 5% of patients who undergo noncardiac surgery will suffer a perioperative myocardial infarction. 1 More than 11% of these patients will die within 30 days of the surgery. Preoperative cardiac risk is commonly determined with the help of risk scores and risk stratification tools, such as the Revised Cardiac Risk Index (RCRI). [2][3][4][5] These scores are of limited utility as intraoperative events that relate to the surgery itself profoundly alter this calculated cardiac risk. 6,7 If these events could be identified and their impact quantified, then surgeons and anaesthetists might be able to intervene to improve perioperative cardiac outcomes.The aim of this meta-analysis was to identify intraoperative factors that changed a patient's preoperative cardiac risk of postoperative cardiac complications. MethodA meta-analysis was conducted to identify modifiable independent intraoperative predictors of postoperative cardiac complications in studies that controlled for preoperative cardiac risk factors. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were adhered to in conducting and reporting this meta-analysis. AbstractBackground: Preoperative cardiac risk is commonly determined with the help of risk scores and risk stratification tools. This predetermined cardiac risk may be profoundly changed by intraoperative surgical events. This meta-analysis aimed to identify intraoperative factors that independently predict postoperative cardiac complications in the presence of preoperative cardiac risk factors.Method: A PubMed Central search was conducted from January 1966 to June 2010, to identify independent intraoperative predictors of postoperative cardiac complications in observational perioperative studies and randomised controlled trials which controlled for preoperative cardiac risk factors.Results: Eleven studies were identified for inclusion in this meta-analysis. Intraoperative blood transfusion [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.8-3.4] was the only independent intraoperative risk predictor identified in more than one study. Other identified independent intraoperative factors included a > 20 mmHg fall in mean arterial blood pressure for > 60 minutes (OR 3.0, 95% CI 1.8-4.9), > 30% increase in baseline systolic pressure (OR 8.0,, tachycardia in the recovery room (> 30 beats per minute from baseline for > 5 minutes) (OR 7, 95% 1.9-26), new onset atrial fibrillation (OR 6.6, 95% CI 2.5-20), hypothermia (OR 2.2, 95% CI 1.1-5) and remote ischaemic preconditioning (OR 0.22, 95% CI 0.07-0.67). None of these studies controlled for blood transfusion.Conclusion: Both surgical and haemodynamic intraoperative events significantly increased the risk of postoperative cardiac complications. Intraoperative blood transfusion has the strongest evidence that supports this finding. It is poss...

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“…were the first to publish on the phenomenon of RIC in the setting of major vascular surgery 88. Patients having elective open AAA repair were randomly assigned to have a protocol of RIC that involved two epsiodes of 10 min ischaemia followed by reperfusion.…”

Section: Ric In Major Non‐cardiac Vascular Surgerymentioning

confidence: 99%

Remote ischaemic conditioning: cardiac protection from afar

2015

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For patients with ischaemic heart disease, remote ischaemic conditioning may offer an innovative, non‐invasive and virtually cost‐free therapy for protecting the myocardium against the detrimental effects of acute ischaemia‐reperfusion injury, preserving cardiac function and improving clinical outcomes. The intriguing phenomenon of remote ischaemic conditioning was first discovered over 20 years ago, when it was shown that the heart could be rendered resistant to acute ischaemia‐reperfusion injury by applying one or more cycles of brief ischaemia and reperfusion to an organ or tissue away from the heart – initially termed ‘cardioprotection at a distance’. Subsequent pre‐clinical and then clinical studies made the important discovery that remote ischaemic conditioning could be elicited non‐invasively, by inducing brief ischaemia and reperfusion to the upper or lower limb using a cuff. The actual mechanism underlying remote ischaemic conditioning cardioprotection remains unclear, although a neuro‐hormonal pathway has been implicated. Since its initial discovery in 1993, the first proof‐of‐concept clinical studies of remote ischaemic conditioning followed in 2006, and now multicentre clinical outcome studies are underway. In this review article, we explore the potential mechanisms underlying this academic curiosity, and assess the success of its application in the clinical setting.

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Remote Ischemic Preconditioning Reduces Myocardial and Renal Injury After Elective Abdominal Aortic Aneurysm Repair

Cited by 336 publications

References 42 publications

Ischemic pre and postconditioning in skeletal muscle injury produced by ischemia and reperfusion in rats

Ischemic pre and postconditioning in skeletal muscle injury produced by ischemia and reperfusion in rats

A meta-analysis of intraoperative factors associated with postoperative cardiac complications

Remote ischaemic conditioning: cardiac protection from afar

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