What is the clinical evidence from this study?

Study design: Other. Population: Double valve replacement (n=40). Intervention: Ischemic preconditioning vs. No preconditioning. Primary outcome: Myocardial MDA after reperfusion for 30 min.

What question did this study set out to answer?

To determine whether ischemic preconditioning enhances myocardial protection during cold-blood cardioplegic arrest in valve replacement surgery and to explore its underlying mechanisms.

May 1, 1999European Journal of Cardio-Thoracic SurgeryOpen Access

Ischemic preconditioning improves preservation with cold blood cardioplegia in valve replacement patients

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Key result

Ischemic preconditioning significantly reduced myocardial MDA (2.6 vs. 3.8 nM/mg) and CK-MB release (77.5 vs. 136.5 IU/l) compared to controls in patients undergoing double valve replacement.

Why the study?

Does ischemic preconditioning improve myocardial protection in patients requiring double valve replacement undergoing cold-blood cardioplegic arrest?

Population

40 patients requiring double valve replacement

Comparison

Ischemic preconditioning before cardioplegic… vs No preconditioning before cardioplegic arrest…

Design

Cohort

Follow-up

12 hours post-reperfusion

Authors

LGLI Guo-huNorthwest A&F University SCShenxi ChenChangsha Medical University ELErxiong LuKK Women's and Children's Hospital

Discussion

Member takes

Implication

Ischemic preconditioning was associated with lower injury markers in double valve replacement; hypothesis-generating and requires randomized confirmation before practice change.

Key Points

To determine whether ischemic preconditioning enhances myocardial protection during cold-blood cardioplegic arrest in valve replacement surgery and to explore its underlying mechanisms.
Studied 40 patients undergoing double valve replacement during cardiopulmonary bypass.
Assigned 20 patients to ischemic preconditioning (two cycles of 3-minute aortic cross-clamping and 2-minute reperfusion before cardioplegic arrest) and 20 patients to an unconditioned control group.
Arrested all hearts using 4°C cold-blood cardioplegia and measured myocardial ultrastructure, tissue T-SOD and MDA, arterial and coronary sinus CGRP and CK-MB, and hemodynamic parameters.
At 30 minutes after reperfusion, the preconditioned group showed significantly reduced myocardial MDA (2.6 ± 0.2 vs. 3.8 ± 0.3 nM/mg) and elevated T-SOD activity (13.1 ± 12.1 vs. 9.2 ± 1.2 IU/mg) compared to controls.
Ischemic preconditioning markedly increased myocardial CGRP release at reperfusion onset (95.3 ± 3.8 vs. 61.2 ± 4.9 pg/ml) and decreased CK-MB levels at 12 hours post-reperfusion (77.5 ± 9.2 vs. 136.5 ± 8.9 IU/l).
Cardiac index values were significantly higher in preconditioned patients at both 30 minutes (2.8 ± 0.3 vs. 2.3 ± 0.2 l/min/m²) and 12 hours post-reperfusion (2.9 ± 0.1 vs. 2.4 ± 0.2 l/min/m²).

Structured PICO

Does ischemic preconditioning improve myocardial protection in patients requiring double valve replacement undergoing cold-blood cardioplegic arrest?

Population

40 patients requiring double valve replacement undergoing cold-blood cardioplegic arrest.

Intervention

Ischemic preconditioning (two cycles of 3 min of aortic cross-clamping and 2 min of reperfusion) before cardioplegic arrest with 4 degrees C cold-blood cardioplegic solution

Comparator

No preconditioning before cardioplegic arrest with 4 degrees C cold-blood cardioplegic solution

Outcome

Myocardial protection measured by calcitonin gene-related peptide (CGRP), creatine kinase-MB (CK-MB), superoxide dismutase/malondialdehyde (T-SOD/MDA), and hemodynamic data (cardiac index)surrogate

Main Result

Absolute Event Rate: 2.6% vs 3.8%

Ischemic preconditioning prior to cold-blood cardioplegic arrest in double valve replacement surgery improves myocardial protection and cardiac function, likely by decreasing oxygen free radical production.

Cite This Study

Guo-hu et al. (1999) studied Double valve replacement (n=40). Ischemic preconditioning vs. No preconditioning was evaluated on Myocardial MDA after reperfusion for 30 min. Ischemic preconditioning significantly reduced myocardial MDA (2.6 vs. 3.8 nM/mg) and CK-MB release (77.5 vs. 136.5 IU/l) compared to controls in patients undergoing double valve replacement.

synapsesocial.com/papers/6aa01b9d0fbdfd5dd81def54 https://doi.org/10.1016/s1010-7940(99)00070-6

Topics

Valvular heart disease

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Implication

Ischemic preconditioning was associated with lower injury markers in double valve replacement; hypothesis-generating and requires randomized confirmation before practice change.

Ischemic preconditioning improves preservation with cold blood cardioplegia in valve replacement patients

Discussion

Member takes

Implication

Key Points

Structured PICO

Main Result

Cite This Study

Topics

Ischemic preconditioning improves preservation with cold blood cardioplegia in valve replacement patients

Discussion

Member takes

Implication

Key Points

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

Also Consider