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 |