Remote Ischaemic Preconditioning Protects Against Cardiopulmonary Bypass-induced Tissue Injury: a Preclinical Study

Overview

Journal Heart

Date 2006 Jul 5

PMID 16818489

Citations 18

Authors

R K Kharbanda

J Li

I E Konstantinov

M M H Cheung

P A White

H Frndova

J Stokoe

P Cox

M Vogel

G Van Arsdell

R Macallister

A N Redington

Affiliations

Soon will be listed here.

Abstract

Objectives: To test the hypothesis that remote ischaemic preconditioning (rIPC) reduces injury after cardiopulmonary bypass (CPB).

Design: Randomised study with an experimental model of CPB (3 h CPB with 2 h of cardioplegic arrest). Twelve 15 kg pigs were randomly assigned to control or rIPC before CPB and followed up for 6 h.

Intervention: rIPC was induced by four 5 min cycles of lower limb ischaemia before CPB.

Main Outcome Measures: Troponin I, glial protein S-100B, lactate concentrations, load-independent indices (conductance catheter) of systolic and diastolic function, and pulmonary resistance and compliance were measured before and for 6 h after CPB.

Results: Troponin I increased after CPB in both groups but during reperfusion the rIPC group had lower concentrations than controls (mean area under the curve -57.3 (SEM 7.3) v 89.0 (11.6) ng.h/ml, p = 0.02). Lactate increased after CPB in both groups but during reperfusion the control group had significantly more prolonged hyperlactataemia (p = 0.04). S-100B did not differ between groups. Indices of ventricular function did not differ. There was a tendency to improved lung compliance (p = 0.07), and pulmonary resistance changed less in the rIPC than in the control group during reperfusion (p = 0.02). Subsequently, peak inspiratory pressure was lower (p = 0.001).

Conclusion: rIPC significantly attenuated clinically relevant markers of myocardial and pulmonary injury after CPB. Transient limb ischaemia as an rIPC stimulus has potentially important clinical applications.

Citing Articles

The effects of ischaemic conditioning on lung ischaemia-reperfusion injury.

Vlastos D, Zeinah M, Ninkovic-Hall G, Vlachos S, Salem A, Asonitis A Respir Res. 2022; 23(1):351.

PMID: 36527070 PMC: 9756694. DOI: 10.1186/s12931-022-02288-z.

Hepatic Remote Ischemic Preconditioning (RIPC) Protects Heart Damages Induced by Ischemia Reperfusion Injury in Mice.

Ren Y, Lin S, Liu W, Ding H Front Physiol. 2021; 12:713564.

PMID: 34671267 PMC: 8520907. DOI: 10.3389/fphys.2021.713564.

The effect of remote ischemic preconditioning on serum creatinine in patients undergoing partial nephrectomy: a study protocol for a randomized controlled trial.

Hur M, Park S, Shin J, Choi J, Yoo S, Kim W Trials. 2018; 19(1):473.

PMID: 30180887 PMC: 6123977. DOI: 10.1186/s13063-018-2820-3.

Preconditioning in neuroprotection: From hypoxia to ischemia.

Li S, Hafeez A, Noorulla F, Geng X, Shao G, Ren C Prog Neurobiol. 2017; 157:79-91.

PMID: 28110083 PMC: 5515698. DOI: 10.1016/j.pneurobio.2017.01.001.

Profiling of cell stress protein expression in cardiac tissue of cardiosurgical patients undergoing remote ischemic preconditioning: implications for thioredoxin in cardioprotection.

Zitta K, Meybohm P, Gruenewald M, Cremer J, Zacharowski K, Scholz J J Transl Med. 2015; 13:34.

PMID: 25622749 PMC: 4316390. DOI: 10.1186/s12967-015-0403-6.

References

Chaturvedi R, Hjortdal V, Stenbog E, Ravn H, White P, Christensen T . Inhibition of nitric oxide synthesis improves left ventricular contractility in neonatal pigs late after cardiopulmonary bypass. Heart. 1999; 82(6):740-4. PMC: 1729213. DOI: 10.1136/hrt.82.6.740. View

Perrault L, Menasche P, Bel A, de Chaumaray T, Peynet J, Mondry A . Ischemic preconditioning in cardiac surgery: a word of caution. J Thorac Cardiovasc Surg. 1996; 112(5):1378-86. DOI: 10.1016/s0022-5223(96)70155-1. View

Charpie J, Dekeon M, Goldberg C, Mosca R, Bove E, Kulik T . Serial blood lactate measurements predict early outcome after neonatal repair or palliation for complex congenital heart disease. J Thorac Cardiovasc Surg. 2000; 120(1):73-80. DOI: 10.1067/mtc.2000.106838. View

Massoudy P, Zahler S, Becker B, Braun S, Barankay A, Meisner H . Evidence for inflammatory responses of the lungs during coronary artery bypass grafting with cardiopulmonary bypass. Chest. 2001; 119(1):31-6. DOI: 10.1378/chest.119.1.31. View

Massoudy P, Zahler S, Becker B, Braun S, Barankay A, Richter J . Significant leukocyte and platelet retention during pulmonary passage after declamping of the aorta in CABG patients. Eur J Med Res. 1999; 4(5):178-82. View

Rimensberger P, Cox P, Frndova H, Bryan A . The open lung during small tidal volume ventilation: concepts of recruitment and "optimal" positive end-expiratory pressure. Crit Care Med. 1999; 27(9):1946-52. DOI: 10.1097/00003246-199909000-00038. View

Li J, Schulze-Neick I, Lincoln C, Shore D, Scallan M, Bush A . Oxygen consumption after cardiopulmonary bypass surgery in children: determinants and implications. J Thorac Cardiovasc Surg. 2000; 119(3):525-33. DOI: 10.1016/s0022-5223(00)70132-2. View

Davies A, Bellomo R, Raman J, Gutteridge G, Buxton B . High lactate predicts the failure of intraaortic balloon pumping after cardiac surgery. Ann Thorac Surg. 2001; 71(5):1415-20. DOI: 10.1016/s0003-4975(01)02469-9. View

Schulze-Neick I, Li J, Penny D, Redington A . Pulmonary vascular resistance after cardiopulmonary bypass in infants: effect on postoperative recovery. J Thorac Cardiovasc Surg. 2001; 121(6):1033-9. DOI: 10.1067/mtc.2001.113747. View

10.

Chew M, Brandslund I, Brix-Christensen V, Ravn H, Hjortdal V, Pedersen J . Tissue injury and the inflammatory response to pediatric cardiac surgery with cardiopulmonary bypass: a descriptive study. Anesthesiology. 2001; 94(5):745-53; discussion 5A. DOI: 10.1097/00000542-200105000-00010. View

11.

Ng C, Wan S, Yim A, Arifi A . Pulmonary dysfunction after cardiac surgery. Chest. 2002; 121(4):1269-77. DOI: 10.1378/chest.121.4.1269. View

12.

Harkin D, DSa A, McCallion K, Hoper M, Campbell F . Ischemic preconditioning before lower limb ischemia--reperfusion protects against acute lung injury. J Vasc Surg. 2002; 35(6):1264-73. DOI: 10.1067/mva.2002.121981. View

13.

Kharbanda R, Mortensen U, White P, Kristiansen S, Schmidt M, Hoschtitzky J . Transient limb ischemia induces remote ischemic preconditioning in vivo. Circulation. 2002; 106(23):2881-3. DOI: 10.1161/01.cir.0000043806.51912.9b. View

14.

Hoffman T, Wernovsky G, Atz A, Kulik T, Nelson D, Chang A . Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation. 2003; 107(7):996-1002. DOI: 10.1161/01.cir.0000051365.81920.28. View

15.

Przyklenk K, Darling C, Dickson E, Whittaker P . Cardioprotection 'outside the box'--the evolving paradigm of remote preconditioning. Basic Res Cardiol. 2003; 98(3):149-57. DOI: 10.1007/s00395-003-0406-y. View

16.

Konstantinov I, Arab S, Kharbanda R, Li J, Cheung M, Cherepanov V . The remote ischemic preconditioning stimulus modifies inflammatory gene expression in humans. Physiol Genomics. 2004; 19(1):143-50. DOI: 10.1152/physiolgenomics.00046.2004. View

17.

Yellon D, Alkhulaifi A, Pugsley W . Preconditioning the human myocardium. Lancet. 1993; 342(8866):276-7. DOI: 10.1016/0140-6736(93)91819-8. View