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Erschienen in: Basic Research in Cardiology 4/2011

01.07.2011 | Original Contribution

Remote intermittent ischemia before coronary artery bypass graft surgery: a strategy to reduce injury and inflammation?

verfasst von: Partheeban Karuppasamy, Sanjay Chaubey, Tracy Dew, Rebecca Musto, Roy Sherwood, Jatin Desai, Lindsay John, Ajay M. Shah, Michael S. Marber, Gudrun Kunst

Erschienen in: Basic Research in Cardiology | Ausgabe 4/2011

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Abstract

Perioperative myocardial ischemia contributes to postoperative morbidity and mortality. Remote intermittent ischemia (RI) has been shown to benefit patients undergoing coronary artery bypass graft (CABG) surgery by decreasing postoperative cardiac troponin levels. In addition, there is evidence that volatile anesthetics may provide myocardial protection. In this prospective randomized controlled trial we tested the hypothesis that RI is cardioprotective under a strict anesthetic regime with volatile anesthesia until cardiopulmonary bypass (CPB). We also assessed whether RI modulates postoperative cytokine and growth factor concentrations. Fifty-four patients referred for elective CABG surgery without concomitant valve or aortic surgery were randomized to three 5-min cycles of left upper limb ischemia by cuff inflation (RI) or placebo without cuff inflation (Plac). All patients received the volatile anesthetic isoflurane (1.15–1.5 vol%) before CPB and the intravenous anesthetic propofol (3–4 mg/kg/h) thereafter until the end of surgery. Cardiac arrest during CPB was induced by intermittent cross-clamp fibrillation, or by blood cardioplegia. We excluded patients older than 85 years, with unstable angina, significant renal disease, and those taking sulfonylureas. Troponin I (cTnI) was measured preoperatively and after 6, 12, 24 and 48 h. In addition, brain natriuretic peptide (BNP), creatine kinase (CKMB) and a panel of cytokines and growth factors were analyzed perioperatively. Although cTnI, BNP and CKMB all increased post-CABG, there were no significant differences between RI and Plac groups; area under the curve for cTnI 189.4 (183.6) ng/mL/48 h and 183.0 (155.2) ng/mL/48 h mean (SD), p = 0.90, respectively, despite a tendency to a shorter (p < 0.07) cross-clamp time in the treatment group. Similarly, there were no differences between groups in the central venous concentrations of numerous cytokines and growth factors. In patients undergoing CABG surgery RI does not provide myocardial protection under a strict anesthetic regime with volatile anesthesia until CPB, and RI was not associated with changes in cytokines.
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Metadaten
Titel
Remote intermittent ischemia before coronary artery bypass graft surgery: a strategy to reduce injury and inflammation?
verfasst von
Partheeban Karuppasamy
Sanjay Chaubey
Tracy Dew
Rebecca Musto
Roy Sherwood
Jatin Desai
Lindsay John
Ajay M. Shah
Michael S. Marber
Gudrun Kunst
Publikationsdatum
01.07.2011
Verlag
Springer-Verlag
Erschienen in
Basic Research in Cardiology / Ausgabe 4/2011
Print ISSN: 0300-8428
Elektronische ISSN: 1435-1803
DOI
https://doi.org/10.1007/s00395-011-0185-9

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