Cardiopulmonary Protection of Modified Remote Ischemic Preconditioning in Mitral Valve Replacement Surgery: A Randomized Controlled Trial

IF 3.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Therapeutics Pub Date : 2024-06-24 DOI:10.1155/2024/9889995

Lianqin Zhang, Kang Zhou, Tianchu Gu, Jingjing Xu, Mengzhu Shi, Jiang Zhu, Jindong Liu

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Abstract

Background: Remote ischemic preconditioning (RIPC) is reported to have early-phase and delayed-phase organ-protective effects. Previous studies have focused on the organ protection of a single RIPC protocol, and the clinical outcomes remain uncertain. Whether the modified RIPC (mRIPC) protocol performed repeatedly provides cardiopulmonary protection is still uncertain.

Methods: In this single-center, randomized, controlled trial, 86 patients undergoing elective mitral valve replacement (MVR) surgery were randomized 1:1 to receive either mRIPC or no ischemic preconditioning (control). Three cycles of 5 min ischemia and 5 min reperfusion induced by a blood pressure cuff served as the RIPC stimulus. mRIPC was induced at the following three time points: 24 h, 12 h, and 1 h before surgery. Blood samples were withdrawn at 10 min after intubation (T0), at 1 h after aortic declamping (T1), and at 6 h (T2), 12 h (T3), and 24 h (T4) after surgery to measure the serum concentrations of myocardial enzymes and other biomarkers, including cardiac troponin I (cTnI), which was the primary endpoint of this study. Creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH), inotropic score (IS), and inflammatory mediators were also measured. Blood gas analysis was conducted to calculate the PaO₂/FiO₂ ratio and A-aDO₂, and the incidence of acute lung injury (ALI) was also recorded.

Results: mRIPC significantly decreased the serum concentrations of cTnI, CK-MB, and LDH at T2, T3, and T4 (p < 0.01), and the IS decreased compared with that in the control group (12.0 ± 1.0 vs. 14.2 ± 1.1, p < 0.01). In addition, the incidence of ALI in the mRIPC group was decreased (32.6% vs. 51.2%, p = 0.039), and the PaO₂/FiO₂ was higher at T4 (p < 0.05). Compared with those in the control group, the levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were decreased at T1, T2, T3, and T4 (p < 0.05) in the mRIPC group, and the level of IL-10 increased at the same time.

Conclusions: mRIPC decreased the incidence of myocardial and lung injury in MVR surgery, providing new evidence for the clinical application of RIPC in valve surgery.

Trial Registration: ClinicalTrials.gov (NCT01406678).

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二尖瓣置换手术中改良远程缺血预处理的心肺保护作用：随机对照试验

背景：据报道，远程缺血预处理（RIPC）具有早期和延迟期器官保护作用。以往的研究主要集中在单一 RIPC 方案的器官保护作用上，临床结果仍不确定。反复进行的改良RIPC（mRIPC）方案是否能提供心肺保护仍不确定：在这项单中心随机对照试验中，86 名接受二尖瓣置换术（MVR）的患者按 1:1 随机分配接受 mRIPC 或不接受缺血预处理（对照组）。在以下三个时间点诱导 mRIPC：24 小时、12 小时和 1 小时：手术前 24 小时、12 小时和 1 小时。在插管后 10 分钟（T0）、主动脉瓣关闭后 1 小时（T1）、术后 6 小时（T2）、12 小时（T3）和 24 小时（T4）抽取血样，以测量心肌酶和其他生物标志物的血清浓度，包括本研究的主要终点--心肌肌钙蛋白 I（cTnI）。此外还测量了肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）、肌力评分（IS）和炎症介质。结果：与对照组相比，mRIPC 可显著降低 T2、T3 和 T4 期血清中 cTnI、CK-MB 和 LDH 的浓度（p < 0.01），IS 也有所降低（12.0 ± 1.0 vs. 14.2 ± 1.1，p < 0.01）。此外，mRIPC 组的 ALI 发生率降低（32.6% 对 51.2%，p = 0.039），T4 时的 PaO2/FiO2 较高（p <0.05）。与对照组相比，mRIPC组白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的水平在T1、T2、T3和T4时均有所下降（p <0.05），IL-10的水平同时有所上升：试验注册：ClinicalTrials.gov (NCT01406678)。

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来源期刊

Cardiovascular Therapeutics 医学-心血管系统

CiteScore

5.60

自引率

0.00%

发文量

审稿时长

6 months

期刊介绍： Cardiovascular Therapeutics (formerly Cardiovascular Drug Reviews) is a peer-reviewed, Open Access journal that publishes original research and review articles focusing on cardiovascular and clinical pharmacology, as well as clinical trials of new cardiovascular therapies. Articles on translational research, pharmacogenomics and personalized medicine, device, gene and cell therapies, and pharmacoepidemiology are also encouraged. Subject areas include (but are by no means limited to): Acute coronary syndrome Arrhythmias Atherosclerosis Basic cardiac electrophysiology Cardiac catheterization Cardiac remodeling Coagulation and thrombosis Diabetic cardiovascular disease Heart failure (systolic HF, HFrEF, diastolic HF, HFpEF) Hyperlipidemia Hypertension Ischemic heart disease Vascular biology Ventricular assist devices Molecular cardio-biology Myocardial regeneration Lipoprotein metabolism Radial artery access Percutaneous coronary intervention Transcatheter aortic and mitral valve replacement.