Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2022; 19 (4): 287-392 ➤ Кардиопротективные эффекты ишемического посткондиционирования при протезировании аортального клапана

Cardioprotective effects of ischemic postconditioning in patients undergoing aortic valve replacement

Authors: Karpova L.I., Radovskiy A.M., Marichev A.O., Etin V.L., Savelyeva A.A., Avezov D.A., Vasilyeva E.Yu., Ivanova M.L., Batalina E.V., Grebennik V.K., Gordeev M.L., Bautin A.E.

Company:
1 1 Almazov National Medical Research Centre, St. Petersburg, Russian Federation
2 St. Petersburg State Pediatric Medical University, St. Petersburg, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2022-19-4-349-360

UDC: 616.126.52-089.28

Link: Clinical Physiology of Blood Circulaiton. 2022; 4 (19): 349-361

Quote as: Karpova L.I., Radovskiy A.M., Marichev A.O., Etin V.L., Savelyeva A.A., Avezov D.A., Vasilyeva E.Yu., Ivanova M.L., Batalina E.V., Grebennik V.K., Gordeev M.L., Bautin A.E. Cardioprotective effects of ischemic postconditioning in patients undergoing aortic valve replacement. Clinical Physiology of Circulation. 2022; 19 (4): 349–60 (in Russ.). DOI: 10.24022/ 1814-6910-2022-19-4-349-360

Keywords:  ischemic postconditioning ischemia-reperfusion injury cardiac surgery cardioprotection aortic valve replacement

Received / Accepted:  18.07.2022 / 12.10.2022

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Abstract

The objective – to increase the effectiveness of myocardial protection during aortic valve replacement (AVR) by applying ischemic postconditioning (IPostCond).

Material and Methods. A prospective randomized study included 78 patients aged 18 to 75 years undergoing AVR in conditions of cardiopulmonary bypass (CPB). All patients were divided into 4 groups: 1) IPostCondSev – performing IPostCond, anesthesia based on sevoflurane (n = 20); 2) IPostCondProp – performing IPostCond, anesthesia based on propofol (n = 19); 3) ContrSev – IPostCond procedure is not performed, anesthesia based on sevoflurane (n = 20); 4) ContrProp – no IPostCond procedure, anesthesia based on propofol (n = 19). To assess cardioprotection, the concentration of troponin T (TnT) was determined before surgery – in 6, 18, 24, 48, and 72 hours after switching off the CPB device. Hemodynamic parameters and the clinical course of the postoperative period were also considered.

Results. A statistically significant decrease in the concentration of TnT was found in the IPostCond group during anesthesia with sevoflurane compared with the control group after 6, 18 and 48 hours: IPostCond 358.2 (304; 470) ng/ml, ContrSev 550.1 (360.7; 782) ng/mL at 6 hours (p = 0.021); IPostCond 292.1 (232.7; 388) ng/ml, ContrSev 347.9 (291.6; 661.4) ng/ml after 18 hours (p = 0.033); IPostCond 252.1 (206.5; 283.7) ng/ml, ContrSev 289.8 (241; 431.6) ng/ml after 48 hours (p = 0.048). The indicator of the maximum TnT concentration was statistically lower in the IPostCondSev group: 358.2 (308.8; 470) ng/ml, versus 646.1 (360.7; 782) ng/ml in the ContrSev group (p = 0.005). The area under the TnT concentration curve was significantly lower in the IPostCondSev group: 18240.4 (16355; 22904.9) versus 24196.1 (19276.6; 35084.9) ng/ml/72 h in the ContrSev group (p = 0.017). There were no significant differences in TnT concentration between the control group and IPostCond group when anesthesia with propofol was used. A significant decrease in the incidence of ventricular fibrillation (VF) and the use of electrical impulse therapy (EIT) was found at the stage of recovery of independent cardiac activity after removal of the clamp from the aorta, comparing with both anesthesia with sevoflurane and propofol: VF IPostCondSev 2 cases (10%) vs. 11 (55 %) in the ContrSev group (p < 0.01), EIT IPostCondSev 2 cases (10%) versus 10 (50%) in the ContrSev group (p < 0.01); VF IPostCondProp 3 cases (15.8%) versus 12 (63.2%) in the ContrProp group (p < 0.01), EIT IPostCondProp 2 cases (10.5%) versus 9 (47.4%) (p < 0.01). There were no other statistically significant differences in the data of the clinical course of the perioperative period, as well as in the indicators of central hemodynamics between the groups.

Conclusion. IPostCond has cardioprotective properties in AVR under CPB conditions. The use of IPostCond in AVR is accompanied by a decrease of the concentration of TnT during anesthesia with sevoflurane and does not have such an effect during anesthesia with propofol. IPostCond reduces the frequency of VF development and EIT at the stage of restoration of independent cardiac activity.

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  1. Ball L., Costantino F., Pelosi P. Postoperative complications of patients undergoing cardiac surgery. Curr. Opin. Crit. Care. 2016; 22 (4): 386–92. DOI: 10.1097/MCC0000000000000319
  2. Turer A.T., Hill J.A. Pathogenesis of myocardial ischemia-reperfusion injury and rationale for therahy. Am. J. Cardiol. 2010; 106 (3): 360–8. DOI: 10.1016/j.amjcard.2010.03.032
  3. Hausenloy D.J., Yellon D.M. Myocardial ischemia-reperfusion injury: a neglected therapeutic target. J. Clin. Invest. 2013; 123 (1): 92–100. DOI: 10.1172/JС162874
  4. Murphy E., Steenbergen C. Mechanisms underlying acute protection from cardiac ischemia-reperfusion injury. Physiol. Rev. 2008; 88 (2): 581–609. DOI: 10.1152/physrev.00024.2007
  5. Murry C., Jennings R., Reimer K. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation. 1986; 74 (5): 1124–36. DOI: 10.1161/01.cir.74.5.1124
  6. Zhao Z.Q., Corvera J.S., Halkos M.E., Kerendi F., Wang N.P., Guyton R.A. et al. Inhibition of myocardial injury by ischemic postconditioning during reperfusion: comparison with ischemic preconditioning. Am. J. Physiol. Heart Circ. Physiol. 2003; 285 (2): 579–88. DOI: 10.1152/ajpheart.01064.2002
  7. Bousselmy R., Lebbi M.A., Ferjani M. Myocardial ischemic conditioning: Physiological aspects and clinical applications in cardiac surgery. J. Saudi Heart Assoc. 2016; 26 (2): 93–100. DOI: 10.1016/j.jsha.2013.11.001
  8. Ovize M., Baxter G.F., Lisa F.D., Ferdinandy P., Garcia-Dorado D., Hausenloy D.J. et al. Postconditioning and protection from reperfusion injury: where do we stand? Position paper from the Working Group of Cellular Biology of the Heart of the European Society of Cardiology. Cardiovasc. Res. 2010; 1; 87 (3): 406–23. DOI: 10.1093/сvr/сvq129
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About Authors

  • Lyudmila I. Karpova, Anesthesiologist-Intensivist; ORCID
  • Aleksey M. Radovskiy, Anesthesiologist-Intensivist; ORCID
  • Aleksandr O. Marichev, Cand. Med. Sci., Head of Department; ORCID
  • Vladimir L. Etin, Researcher; ORCID
  • Aleksandra A. Savelyeva, Cand. Med. Sci., Anesthesiologist-Intensivist; ORCID
  • Denis A. Avezov, Student; ORCID
  • Elena Yu. Vasilyeva, Head of Central Clinical Diagnostic Laboratory; ORCID
  • Mariya L. Ivanova, Physician of Clinical Diagnostics Laboratory; ORCID
  • Evgeniya V. Batalina, Physician of Clinical Diagnostics Laboratory; ORCID
  • Vadim K. Grebennik, Head of Department; ORCID
  • Mikhail L. Gordeev, Dr. Med. Sci., Professor, Head of the Department; ORCID
  • Andrey E. Bautin, Dr. Med. Sci., Associate Professor, Head of Anesthesiology and Intensive Care Research Division; ORCID

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