Radovskij A.M., Bautin A.E., Karpova L.I., Marichev A.O., Abutalimova N.R., Vasileva E.Yu., Blohina N.V., Kucherenko V.S., Grebennik V.K.
Almazov National Medical Research Center, Saint-Petersburg
Aim. To increase the efficiency of intraoperative cardioprotection during coronary artery bypass grafting (CABG) by using of a modified technique of remote ischemic preconditioning (RIPC).
Materials and Methods. 63 patients which were scheduled for CABG were included into the prospective, randomized study. Three groups were formed after randomization: 1) Control group — without RIPC (CONTROL), 2) RIPC1 — RIP with ischemia-reperfusion of one lower limb (RIPC1), 3) RIPC2 — RIPC with ischemia-reperfusion of two lower limbs (RIP2). RIPC protocol: three five-minutes episodes of one or two lower limbs ischemia with five-minutes reperfusion intervals. Troponin I (cTnI) level were assessed prior to induction of anesthesia, at 30 min, 12, 24, 36 and 48 hours after the cessation of CPB. Significant differences were assessed by the nonparametric Mann-Whitney and Fisher’s exact tests. Data are presented as median (25th percentile, 75th percentile).
Results. Significant differences in cTnI were found between CONTROL and RIPC2 groups at 12, 36 and 48 hours: CONTROL 1,82 (1,26; 2,33) ng/ml, RIPC2 1,1 (0,75; 1,54) ng/ml respectively at 12 hours (p = 0,01), CONTROL 1,25 (0,74; 1,66) ng/ml, RIPC2 0,79 (0,45; 1,09) ng/ml respectively at 36 hours (p = 0,04), CONTROL 0,85 (0,69; 1,84) ng/ml, RIPC2 0,51 (0,32; 0,92) ng/ml respectively at 48 hours (p = 0,03). Significant differences in cTnI were found between RIPC1 and RIPC2 groups at 12, 24 and 48 hours: RIPC1 1,94 (1,65; 2,44) ng/ml, RIPC2 1,1 (0,75; 1,54) ng/ml respectively at 12 hours (p < 0,001), RIPC1 1,61 (1,25; 1,91) ng/ml, RIPC2 1,16 (0,55; 1,62) ng/ml respectively at 24 hours (p < 0,001), RIPC1 0,85 (0,69; 1,84) ng/ml, RIPC2 0,51 (0,32; 0,92) ng/ml respectively at 48 hours (p = 0,014). There were no significant differences found in cTnI between CONTROL and RIPC1 groups during the whole study. There were no significant differences found in the clinical course of the postoperative period groups.
Conclusions. The modified protocol RIPC with ischemia-reperfusion of two lower limbs has a cardioprotective effect in CABG with CPB. The cardioprotective efficacy of RIPC depends on the volume of tissue affected by ischemia-reperfusion during the implementation of the protocol of RIPC. The modified protocol RIPC does not affect hemodynamics and clinical course of the postoperative period in CABG with CPB.
Keywords: remote ischemic preconditioning; cardiac surgery; cardioprotection, CABG.
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