RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study: Myocardial Dysfunction, Postoperative Neurocognitive Dysfunction, and 1 Year Follow‐Up

Meybohm, Patrick; Kohlhaas, Madeline; Stoppe, Christian; Gruenewald, Matthias; Renner, Jochen; Bein, Berthold; Albrecht, Martín; Cremer, Jochen; Coburn, Mark; Schaelte, G.; Boening, Andreas; Niemann, Bernd; Sander, Michael; Roesner, Jan P.; Kletzin, Frank; Mutlak, Haitham; Westphal, Sabine; Laufenberg-Feldmann, R.; Ferner, Marion; Brandes, Ivo F.; Bauer, Martin; Stehr, Sebastian; Kortgen, Andreas; Wittmann, Maria; Baumgarten, Georg; Meyer-Treschan, Tanja; Kienbaum, Peter; Heringlake, Matthias; Schoen, Julika; Treskatsch, Sascha; Smul, Thorsten M.; Wolwender, Ewa; Schilling, Thomas; Fuernau, Georg; Bogatsch, Holger; Brosteanu, Oana; Hasenclever, Dirk; Zacharowski, Kai

doi:10.1161/jaha.117.008077

Cited by 34 publications

(77 citation statements)

References 41 publications

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“…In addition, clinical studies also suggest that rIPC prevents the deterioration of short-term post-operative cognitive function in cardiac surgery patients [ 117 ], as well as reduces post-operative ischaemic tissue damage in brain tumour surgery [ 119 ]. However, the role of rIPC in neuroprotection has produced conflicting results, with findings from the multicentre, randomised RIPHeart (Remote Ischaemic Preconditioning for Heart Surgery) study demonstrating no effect on neurocognitive function or long-term outcomes in cardiac surgery patients [ 120 ].…”

Section: Therapeutic Options For Post-operative Neurological Complicamentioning

confidence: 99%

Surgery, neuroinflammation and cognitive impairment

et al. 2018

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Trauma experienced during surgery can contribute to the development of a systemic inflammatory response that can cause multi-organ dysfunction or even failure. Post-surgical neuroinflammation is a documented phenomenon that results in synaptic impairment, neuronal dysfunction and death, and impaired neurogenesis. Various pro-inflammatory cytokines, such as TNFα, maintain a state of chronic neuroinflammation, manifesting as post-operative cognitive dysfunction and post-operative delirium. Furthermore, elderly patients with post-operative cognitive dysfunction or delirium are three times more likely to experience permanent cognitive impairment or dementia. We conducted a narrative review, considering evidence extracted from various databases including Pubmed, MEDLINE and EMBASE, as well as journals and book reference lists. We found that further pre-clinical and well-powered clinical studies are required to delineate the precise pathogenesis of post-operative delirium and cognitive dysfunction. Despite the burden of post-operative neurological sequelae, clinical studies investigating therapeutic agents, such as dexmedetomidine, ibuprofen and statins, have yielded conflicting results. In addition, evidence supporting novel therapeutic avenues, such as nicotinic and HMGB-1 targeting and remote ischaemic pre-conditioning, is limited and necessitates further investigation.

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Section: Therapeutic Options For Post-operative Neurological Complicamentioning

confidence: 99%

Surgery, neuroinflammation and cognitive impairment

et al. 2018

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“…While this effect was confirmed by our preceding meta-analysis (see Yang et al [16]), in our study, mortality, morbidity, and other clinical outcomes were not improved. Additionally, several studies [17–19], including two multicenter randomized clinical trials with a larger sample size in cardiac surgery reported by Hausenloy et al [18] and Meybohm et al [19], failed to demonstrate that RIPC exerts beneficial effects in this type of patient.…”

Section: Discussionmentioning

confidence: 99%

Cardioprotective effect of remote ischemic preconditioning with postconditioning on donor hearts in patients undergoing heart transplantation: a single-center, double-blind, randomized controlled trial

et al. 2019

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Background The cardioprotective effect of remote ischemic preconditioning (RIPC) in cardiovascular surgery is controversial. This study investigated whether RIPC combined with remote ischemic postconditioning (RIPostC) reduces myocardial injury to donor hearts in patients undergoing heart transplantation. Methods One hundred and twenty patients scheduled for orthotopic heart transplantation were enrolled and randomly assigned to an RIPC+RIPostC group ( n = 60) or a control (n = 60) group. In the RIPC+RIPostC group, after anesthesia induction, four cycles of 5-min of ischemia and 5-min of reperfusion were applied to the right upper limb by a cuff inflated to 200 mmHg (RIPC) and 20 min after aortic declamping (RIPostC). Serum cardiac troponin I (cTnI) levels were determined preoperatively and at 3, 6, 12, and 24 h after aortic declamping. Postoperative clinical outcomes were recorded. The primary endpoint was a comparison of serum cTnI levels at 6 h after aortic declamping. Results Compared with the preoperative baseline, in both groups, serum cTnI levels peaked at 6 h after aortic declamping. Compared with the control group, RIPC+RIPostC significantly reduced serum cTnI levels at 6 h after aortic declamping (38.87 ± 31.81 vs 69.30 ± 34.13 ng/ml, P = 0.02). There were no significant differences in in-hospital morbidity and mortality between the two groups. Conclusion In patients undergoing orthotopic heart transplantation, RIPC combined with RIPostC reduced myocardial injury at 6 h after aortic declamping, while we found no evidence of this function provided by RIPC+RIPostC could improve clinical outcomes. Trial registration Trial Registration Number: chictr.org.cn . no. ChiCTR-INR-16010234 (prospectively registered). The initial registration date was 9/1/2017.

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“…Bypass Graft Surgery trial) did not nd renoprotective effects of RIPC, and the result was maintained up to 1 year after the surgery in the Remote Ischemic Preconditioning for Heart Surgery study [6]. However, Zarbock and colleagues demonstrated that RIPC, compared with sham treatment, signi cantly reduced the rate of AKI (P =0 .02) and actually reduced the proportions of stage II-III cases (P =0 .02) following cardiac surgery [7].…”

Section: Effect Of Remote Ischemic Preconditioning On Clinical Outcommentioning

confidence: 99%

90 Days Impacts of Remote Ischemic Preconditioning on Patients Undergoing Open Total Aortic Arch Replacement: A Post-Hoc Analysis of a Previous Trial

Chen

Wang

Zhou

et al. 2020

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Background: In the previous randomized controlled trial by our research group, we evaluated the effect of remote ischemic preconditioning (RIPC) in 130 patients (65 per arm) on acute kidney injury (AKI) within 7 days of open total aortic arch replacement. Significantly fewer RIPC-treated patients than sham-treated patients developed postoperative AKI, and, epically, RIPC significantly reduced serious AKI (stage II–III). However, the long-term effect of RIPC in patients undergoing open total aortic arch replacement is unclear. Methods: This study was a post-hoc analysis. We aimed to assess the roles of RIPC in major adverse kidney events (MAKE), defined as consisting persistent renal dysfunction, renal replacement therapy and mortality, within 90 days after surgery in patients receiving open total aortic arch replacement.Results: In this 90-day follow-up study, data were available for all study participants. We found that RIPC failed to improve the presence of MAKE within 90 days after surgery (RIPC: 7 of 65[10.8%]) vs sham: 15 of 65[23.1%]; P=0.061). In those patients who developed AKI after surgery, we found that the rate of MAKE within 90 days after surgery differed between the RIPC group and the sham group (RIPC: 4 of 36[11.2%]; sham: 14 of 48[29.2%]; P=0.046).Conclusions: At 90 days after open total aortic arch replacement, we failed to find a difference between the renoprotective effects of RIPC and sham treatment. The effectiveness or ineffectiveness of RIPC should be further investigated in a large randomized sham-controlled trial.Trial registration: This study was approved by the Ethics Committee of Fuwai Hospital (No. 2016–835) and our previous study was registered at clinicaltrials.gov before patient enrollment (NCT03141385; principal investigator: G.W.; date of registration: March 5, 2017).

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RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study: Myocardial Dysfunction, Postoperative Neurocognitive Dysfunction, and 1 Year Follow‐Up

Cited by 34 publications

References 41 publications

Surgery, neuroinflammation and cognitive impairment

Surgery, neuroinflammation and cognitive impairment

Cardioprotective effect of remote ischemic preconditioning with postconditioning on donor hearts in patients undergoing heart transplantation: a single-center, double-blind, randomized controlled trial

90 Days Impacts of Remote Ischemic Preconditioning on Patients Undergoing Open Total Aortic Arch Replacement: A Post-Hoc Analysis of a Previous Trial

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