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Table 1 Studies including ischemic conditioning

From: Myocardial conditioning techniques in off-pump coronary artery bypass grafting

Author, date, journal and country study type Patient group Type of conditioning Outcomes Key results Comments
Joung et al. (2013) Korean J Anestesiol, Korea [16] Prospective controlled randomized trial Seventy OPCAB RIPC 4 cycles of 5 min ischemia and 5 min of reperfusion before coronary artery anastomoses Six cognitive function test day 1 after surgery Post-operative cognitive dysfunction was 28.6% (10 pts) and 31.4% (11 pts) in RIPC and Control group respectively RIPC did not reduce incidence of post-op cognitive dysfunction after OPCABG during the immediate post-op period
35 RIPC
35 Control
Forouzannia et al. (2013) J The Univ Heart Ctr, Iran [17] Prospective controlled randomized trial Sixty OPCAB Adenosine. Post-op EF IP and adenosine did not elicit statistically significant EF preservation compared to the control group No difference found in post-op EF and enzymes release in between groups. Incidence of arrhythmias was higher in the IP group but did not reach statistical significance
20 Adenosine IP induced with twice 2 min LAD occlusion followed 3 min reperfusion before the first anastomosis Arrhythmias
20 IP Troponin/CK-MB
20 Control
Hong et al. (2012) Circulation Journal, Japan [18] Prospective controlled randomized trial Seventy OPCAB Lower limb 4 cycles of 5 min ischemia and 5 min of reperfusion before anastomoses (RIPC) and after anastomoses (RIPostC) Troponin release RIPC + RIPostC significantly reduced postoperative serum troponin I levels RIPC + RIPostC decreased postoperative myocardial enzyme elevation by almost half postoperatively in patients undergoing OPCAB
35 RIPC + RIPpostC
35 Control
Hong et al. (2010)] Anaesth Intensive Care, Korea [19] Prospective randomized controlled trial 130 OPCAB Upper limb 4 cycles of 5 min ischemia and 5 min of reperfusion after anesthesia Troponin release Troponin release was lower in the RIPC group but was not statistically significant RIPC did not reduce significantly post-operative myocardial enzyme release
65 RIPC
65 Control
Succi et al. (2010) Arq Bras Cardiol, Brasil [20] Prospective controlled randomized trial Forty OPCAB IP induced with twice 1 min LAD occlusion followed 2 min reperfusion before the anastomosis Intra-op EF (measured pulsed Doppler of the descending thoracic aorta) Acceleration of the aortic blood flow with no differences in between groups; IP group maintained left ventricular contractility during the entire procedure while the control group presented significant reduction in left ventricular contractility IP prevented the decrease in left ventricular contractility during off-pump myocardial revascularization surgery
0 IP
20 Control
Drenger et al. (2008) Journal of Cardiothoracic and Vascular Anesthesia, Israel [21] Prospective controlled randomized trial Twenty five OPCAB IP induced with single 5 min LAD occlusion followed by 5 min reperfusion 1.6% ENF started 15 min before LAD occlusion Myocardial metabolism Lactate production in the ENF group decreased significantly compared with control and IP groups. Oxygen utilization in the control was 44% higher than the other two groups. Early recovery of anterior wall hypokinesis in both study group Application of methods such as IP or volatile anesthesia appeared to reduce the metabolic deficit
8 Control
9 IP
8 Enflurane
Wu et al. (2003) Journal of Cardiothoracic and Vascular Anesthesia, Finland [22] Prospective controlled randomized trial Thirty two OPCAB IP induced with twice 2 min LAD occlusion followed 3 min reperfusion before the first anastomosis Incidence of post-operative arrhythmias IP suppressed the HR elevation during the time of myocardial ischemia and reperfusion and significantly reduced the incidence of VT after surgery. Incidence of SVT during 2 to 24 hours after surgery was lower in the IP patients but incidence of SVES, VES, and AF were similar between the 2 groups Arrhythmia was a common phenomenon during and after OPCAB procedure; IP protocol significantly suppressed HR elevation, episodes of SVT, and incidence of VT after surgery but incidence of post-op AF was similar in between groups
16 IP
16 Control
Doi et al. (2003) Jpn J Thorac Cardiovasc Surg, Japan [23] Prospective observational study Forty-five OPCAB (MIDCAB) IP induced with 5 min vessel occlusion followed 5 min reperfusion before anastomosis phiL/phiT, QT, JT dispersions before, during and after IP and during and after coronary anastomosis Anisotropy was exaggerated during the 5-minute coronary occlusion; during anastomosis, conduction velocities were decreased, but showed no further deterioration; QT and JT dispersions were improved by reperfusion Anisotropy and dispersions were minimized after IP, therefore IP demonstrated antiarrhythmic protective effects on the human myocardium
Laurikka et al. (2003) Chest, Finland [14] Prospective controlled randomized trial Thirty-two OPCAB IP induced with cycle of twice 2 min LAD occlusion followed 3 min reperfusion before the first anastomosis Myocardial performance IP group had complete recovery of mean after the operation; in the control subjects, mean SVI showed a significant reduction postoperatively IP tended to decrease the immediate myocardial enzyme release, prohibited the postoperative increase in HR, and enhanced the recovery of SVI
16 IP
16 Control
Matsumoto et al. (2001) Kyobu Geka, Japan [24] Retrospective observational study Forty-three OPCAB IP induced with twice 5 min vessel occlusion followed 5 min reperfusion before anastomosis Allopurinol preoperatively and nicorandil intraoperatively; Myocardial tissue oxygen saturation Troponin level was statistically significant lower in the IP group
On day 1 post op, the increase in the mean HR was also significantly lower in the IP group
Significant amelioration of post-ischemic recovery in the IP + pharmacological preconditioning
Concomitant use of IP and KATP opener, oxidative radical scavenger both ameliorated cardiac dysfunction during ischemia in anastomotic occlusion of the coronary artery and improved the post-ischemic functional recovery
12 IP
29 IP+pharmacological Post-ischemic functional recovery
van Aarnhem et al. (1999) Eur J Cardiothorac Surg, The Netherlands [12] Retrospective observational study Two-hundred OPCAB IP induced with 5 min of local coronary artery occlusion and 5 min of reperfusion before anastomosis Ischemia during temporary coronary artery occlusions Ischemia (defined as defined as > 1 mm S-T segment) occurred during 35 (10%) temporary coronary artery occlusions Temporary segmental occlusion was safe before anastomosis in OPCAB; shunts were used in critical ischemia
Ischemic dysfunction was precipitated by the 5-min LAD occlusion, as shown by the increase in LVWMS and PA pressure. However, a 5-min coronary occlusion and the resulting ischemia did not alter regional LV systolic function during subsequent ischemia
There were no perioperative MI/no conversion to ONCAB LVWMS decreased significantly after first cycle but improved after IP No significant differences in pulmonary artery pressures were after IP and during anastomosis
Malkowski (1998) J Am Coll Cardiol (USA) [13] Prospective observational study Seventeen OPCAB (MIDCAB) IP induced with 5 min of local coronary artery occlusion and 5 min of reperfusion LVWMS
PA systolic and diastolic pressure
  1. AF: Atrial fibrillation; IP: Ischemic preconditioning; I/R: Ischemia reperfusion; LAD: Left anterior descending artery; LVWMS: Left ventricle wall motion score; MIDCAB: Minimally invasive direct coronary artery bypass grafting; ONCAB: On-pump CABG; OPCAB: Off-pump CABG; phiL/phiT: Ratio of longitudinal to transverse conduction velocity PostC: Postconditioning; RIPC: Ischemic remote preconditioning; SVI: Stroke volume index; SS: Sevoflurane.