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01-05-2012 | Invited Editorial

Remote ischemic preconditioning in cardiac surgery: caught between clinical relevance and statistical significance?

Author: Matthias Thielmann

Published in: Basic Research in Cardiology | Issue 3/2012

Excerpt

Remote ischemic preconditioning (RIPC), which consists of brief episodes of ischemia/reperfusion of remote organs, has been convincingly demonstrated to protect the heart from myocardial infarction [3, 9, 16, 26]. RIPC also protects other organs such as brain, lung, liver, and kidney [1, 2, 4, 11, 19, 24, 25]. Recently, RIPC has been brought from the bench to the operating theater. It has been shown in several randomized controlled trials (RCTs) that RIPC attenuates the extent of myocardial injury, as measured by a reduced release of biomarkers reflecting myocardial injury, in various cardiac and vascular surgery scenarios such as abdominal aortic surgery [1], congenital cardiac surgery [4], adult heart valve surgery [14] and coronary artery bypass grafting (CABG) [7, 10, 22]. …

Ali ZA, Callaghan CJ, Lim E, Ali AA, Nouraei SA, Akthar AM, Boyle JR, Varty K, Kharbanda RK, Dutka DP, Gaunt ME (2007) Remote ischemic preconditioning reduces myocardial and renal injury after elective abdominal aortic aneurysm repair: a randomized controlled trial. Circulation 116(11 Suppl):I98–I105. doi:10.1161/circulationaha.106.679167 PubMed

Ateş E, Genç E, Erkasap N, Erkasap S, Akman S, Firat P, Emre S, Kiper H (2002) Renal protection by brief liver ischemia in rats. Transplantation 74:1247–1251. doi:10.1097/01.tp.0000032752.61372.36 PubMedCrossRef

Birnbaum Y, Hale SL, Kloner RA (1997) Ischemic preconditioning at a distance: reduction of myocardial infarct size by partial reduction of blood supply combined with rapid stimulation of the gastrocnemius muscle in the rabbit. Circulation 96:1641. doi:10.1161/01.cir.96.5.1641 PubMed

Cheung MM, Kharbanda RK, Konstantinov IE, Shimizu M, Frndova H, Li J, Holtby HM, Cox PN, Smallhorn JF, Van Arsdell GS, Redington AN (2006) Randomized controlled trial of the effects of remote ischemic preconditioning on children undergoing cardiac surgery: first clinical application in humans. J Am Coll Cardiol 47:2277–2282. doi:10.1016/j.jacc.2006.01.066 PubMedCrossRef

Croal BL, Hillis GS, Gibson PH, Fazal MT, El-Shafei H, Gibson G, Jeffrey RR, Buchan KG, West D, Cuthbertson BH (2006) Relationship between postoperative cardiac troponin I levels and outcome of cardiac surgery. Circulation 114:1468–1475. doi:10.1161/circulationaha.105.602370 PubMedCrossRef

Fellahi JL, Gué X, Richomme X, Monier E, Guillou L, Riou B (2003) Short- and long-term prognostic value of postoperative cardiac troponin I concentration in patients undergoing coronary artery bypass grafting. Anesthesiology 99:270–274PubMedCrossRef

Hausenloy DJ, Mwamure PK, Venugopal V, Harris J, Barnard M, Grundy E, Ashley E, Vichare S, Di Salvo C, Kolvekar S, Hayward M, Keogh B, MacAllister RJ, Yellon DM (2007) Effect of remote ischaemic preconditioning on myocardial injury in patients undergoing coronary artery bypass graft surgery: a randomised controlled trial. Lancet 370:575–579. doi:10.1016/j.bbr.2011.03.031 PubMedCrossRef

Hausenloy DJ, Baxter G, Bell R, Bøtker HE, Davidson SM, Downey J, Heusch G, Kitakaze M, Lecour S, Mentzer R, Mocanu MM, Ovize M, Schulz R, Shannon R, Walker M, Walkinshaw G, Yellon DM (2010) Translating novel strategies for cardioprotection: the Hatter Workshop Recommendations. Basic Res Cardiol 105:677–686. doi:10.1007/s00395-010-0121-4 PubMedCrossRef

Heusch G, Schulz R (2002) Remote preconditioning. J Mol Cell Cardiol 34:1279–1281. doi:10.1006/jmcc.2002.2093 PubMedCrossRef

10.

Heusch G, Musiolik J, Kottenberg E, Peters J, Jakob H, Thielmann M (2012) STAT5 activation and cardioprotection by remote ischemic preconditioning in humans: short communication. Circ Res 110:111–115. doi:10.1161/circresaha.111.259556 PubMedCrossRef

11.

Kanoria S, Jalan R, Davies NA, Seifalian AM, Williams R, Davidson BR (2006) Remote ischaemic preconditioning of the hind limb reduces experimental liver warm ischaemia–reperfusion injury. Br J Surg 93:762–768. doi:10.1002/bjs.5331 PubMedCrossRef

12.

Karuppasamy P, Chaubey S, Dew T, Musto R, Sherwood R, Desai J, John L, Shah AM, Marber MS, Kunst G (2011) Remote intermittent ischemia before coronary artery bypass graft surgery: a strategy to reduce injury and inflammation? Basic Res Cardiol 106:511–519. doi:10.1007/s00395-011-0185-9 PubMedCrossRef

13.

Kottenberg E, Thielmann M, Bergmann L, Heine T, Jakob H, Heusch G, Peters J (2012) Protection by remote ischemic preconditioning during coronary artery bypass graft surgery with isoflurane but not propofol—a clinical trial. Acta Anaesthesiol Scand 56:30–38. doi:10.1111/j.1399-6576.2011.02585 PubMedCrossRef

14.

Li L, Luo W, Huang L, Zhang W, Gao Y, Jiang H, Zhang C, Long L, Chen S (2010) Remote perconditioning reduces myocardial injury in adult valve replacement: a randomized controlled trial. J Surg Res 164:e21–e26. doi:10.1016/j.jss.2010.06.016 PubMedCrossRef

15.

Lucchinetti E, Bestmann L, Feng J, Freidank H, Clanachan AS, Finegan BA, Zaugg M (2012) Remote ischemic preconditioning applied during isoflurane inhalation provides no benefit to the myocardium of patients undergoing on-pump coronary artery bypass graft surgery: lack of synergy or evidence of antagonism in cardioprotection? Anesthesiology 116:296–310. doi:10.1097/aln.0b013e318242349a PubMedCrossRef

16.

Oxman T, Arad M, Klein R, Avazov N, Rabinowitz B (1997) Limb ischemia preconditions the heart against reperfusion tachyarrhythmia. Am J Physiol 273:H1707–H1712PubMed

17.

Peters J (2011) Remote ischaemic preconditioning of the heart: remote questions, remote importance, or remote preconditions? Basic Res Cardiol 106:507–509. doi:10.1007/s00395-011-0187-7 PubMedCrossRef

18.

Rahman IA, Mascaro JG, Steeds RP, Frenneaux MP, Nightingale P, Gosling P, Townsend P, Townend JN, Green D, Bonser RS (2010) Remote ischemic preconditioning in human coronary artery bypass surgery: from promise to disappointment? Circulation 122(11 Suppl):S53–S59. doi:10.1161/circulationaha.109.926667 PubMedCrossRef

19.

Ren C, Gao X, Steinberg GK, Zhao H (2008) Limb remote-preconditioning protects against focal ischemia in rats and contradicts the dogma of therapeutic time windows for preconditioning. Neuroscience 19(151):1099–1103. doi:10.1016/j.neuroscience.2007.11.056 CrossRef

20.

Swaanenburg JC, Loef BG, Volmer M, Boonstra PW, Grandjean JG, Mariani MA, Epema AH (2001) Creatine kinase MB, troponin I, and troponin T release patterns after coronary artery bypass grafting with or without cardiopulmonary bypass and after aortic and mitral valve surgery. Clin Chem 47:584–587PubMed

21.

Schwartz Longacre L, Kloner RA, Arai AE, Baines CP, Bolli R, Braunwald E, Downey J, Gibbons RJ, Gottlieb RA, Heusch G, Jennings RB, Lefer DJ, Mentzer RM, Murphy E, Ovize M, Ping P, Przyklenk K, Sack MN, Vander Heide RS, Vinten-Johansen J, Yellon DM, National Heart, Lung, and Blood Institute, National Institutes of Health (2011) New horizons in cardioprotection: recommendations from the 2010 National Heart, Lung, and Blood Institute Workshop. Circulation 124:1172–1179. doi:10.1161/circulationaha.111.032698 PubMedCrossRef

22.

Thielmann M, Kottenberg E, Boengler K, Raffelsieper C, Neuhaeuser M, Peters J, Jakob H, Heusch G (2010) Remote ischemic preconditioning reduces myocardial injury after coronary artery bypass surgery with crystalloid cardioplegic arrest. Basic Res Cardiol 105:657–664. doi:10.1007/s00395-010-0104-5 PubMedCrossRef

23.

Thielmann M, Massoudy P, Marggraf G, Knipp S, Schmermund A, Piotrowski J, Erbel R, Jakob H (2004) Role of troponin I, myoglobin, and creatine kinase for the detection of early graft failure following coronary artery bypass grafting. Eur J Cardiothorac Surg 26:102–109. doi:10.1016/j.ejcts.2004.03.015 PubMedCrossRef

24.

Venugopal V, Laing CM, Ludman A, Yellon DM, Hausenloy D (2010) Effect of remote ischemic preconditioning on acute kidney injury in nondiabetic patients undergoing coronary artery bypass graft surgery: a secondary analysis of 2 small randomized trials. Am J Kidney Dis 56:1043–1049. doi:10.1053/j.ajkd.2010.07.014 PubMedCrossRef

25.

Waldow T, Alexiou K, Witt W, Albrecht S, Wagner F, Knaut M, Matschke K (2005) Protection against acute porcine lung ischemia/reperfusion injury by systemic preconditioning via hind limb ischemia. Transpl Int 18:198–205. doi:10.1111/j.1432-2277.2004.00005 PubMedCrossRef

26.

Weinbrenner C, Schulze F, Sárváry L, Strasser RH (2004) Remote preconditioning by infrarenal aortic occlusion is operative via delta1-opioid receptors and free radicals in vivo in the rat heart. Cardiovasc Res 61:591–599. doi:10.1016/j.cardiores.2003.10.008 PubMedCrossRef

27.

Young PJ, Dalley P, Garden A, Horrocks C, La Flamme A, Mahon B, Miller J, Pilcher J, Weatherall M, Williams J, Young W, Beasley R (2012) A pilot study investigating the effects of remote ischemic preconditioning in high risk cardiac surgery using a randomised controlled double-blind protocol. Basic Res Cardiol 107:256CrossRef

Title: Remote ischemic preconditioning in cardiac surgery: caught between clinical relevance and statistical significance?
Author: Matthias Thielmann
Publication date: 01-05-2012
Publisher: Springer-Verlag
Published in: Basic Research in Cardiology / Issue 3/2012
Print ISSN: 0300-8428
Electronic ISSN: 1435-1803
DOI: https://doi.org/10.1007/s00395-012-0259-3

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