Effect Of Remote Ischemic Preconditioning Of Human Heart During Coronary Artery Bypass Grafting
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Effect Of Remote Ischemic Preconditioning Of Human Heart During Coronary Artery Bypass Grafting
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Author : Erika Anna Hernekamp
language : en
Publisher:
Release Date : 2017
Effect Of Remote Ischemic Preconditioning Of Human Heart During Coronary Artery Bypass Grafting written by Erika Anna Hernekamp and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2017 with categories.
Application Of Remote Ischaemic Preconditioning To Human Coronary Artery Bypass Surgery
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Author :
language : en
Publisher:
Release Date :
Application Of Remote Ischaemic Preconditioning To Human Coronary Artery Bypass Surgery written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on with categories.
This thesis reports a clinical study designed to assess myocardial, renal and lung outcomes following cardiac surgery. In a single centre, prospective randomized, placebo intervention-controlled trial the effects of intermittent upper limb ischaemia (remote ischaemic preconditioning (RIPC)) were compared in non-diabetic adult patients undergoing on-pump multi-vessel coronary artery surgery. Patients, investigators, anaesthetists, surgeons and critical care teams were all blind to group allocation. Subjects were randomized(1:1) to RIPC(or placebo) stimuli (3x upper limb (or dummy arm) 5 minute cycles of 200mmHg cuff inflation/deflation) during sternotomy and conduit procurement. Anaesthesia, perfusion, cardioplegia and surgical techniques were standardized. Groups were well matched on demographic and operative variables. In contrast to prior smaller studies, RIPC did not reduce troponin T (48 hour area under the curve (AUC); 6hour and peak) release, improve post-operative haemodynamics (cardiac indices; low cardiac output episodes incidence; IABP usage; inotrope and vasoconstrictor use; M mode, 2D contrastenhanced echocardiography and tissue Doppler imaging) or offer antiarrhythmic benefit (de novo left bundle branch block or Q waves; ventricular tachyarrhythmia incidence). RIPC did not afford renal (peak creatinine, AUC urinary albumin-creatinine ratios, dialysis requirement) or lung protection (intubation times, 6hour and 12 hour pO2/FiO2 ratios). Case urgency did not influence RIPC effect.
Remote Ischaemic Preconditioning In The Settings Of Cardiac Bypass Surgery And Coronary Angioplasty
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Author : G. G. Babu
language : en
Publisher:
Release Date : 2012
Remote Ischaemic Preconditioning In The Settings Of Cardiac Bypass Surgery And Coronary Angioplasty written by G. G. Babu and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012 with categories.
Myocardial revascularisation in the form of coronary artery bypass surgery (CABG) and percutaneous coronary interventions (PCI) are the two important treatment strategies in combating ischaemic heart disease. There have been tremendous improvements in many aspects of these revascularisation methods over the years. However both these forms of revascularisation can have a deleterious effect on the myocardium while its vascularity is re-established. This revascularisation induced myocardial injury is one of the prognostically important deleterious effects. Consequently, many therapeutic strategies are being studied which can cardioprotect and reduce peri-operative myocardial injury during CABG and peri-procedural myocardial injury during PCI. We evaluate Remote ischaemic preconditioning, a cardioprotective strategy, for its effect on myocardial revascularisation methods of PCI and CABG. In the PCI settings, the beneficial effect of remote ischaemic preconditioning in patients undergoing elective PCI has now been established. However its role in patients admitted with Non ST elevation acute coronary syndrome (NSEACS) and undergoing urgent PCI is still unknown. This group of patients particularly has increased peri-procedural myocardial injury due to their soft coronary plaque and thrombi. In the CABG settings, remote preconditioning has been shown reduce perioperative myocardial injury in non diabetic patients. There are no clinical studies looking at the beneficial effect of remote preconditioning in diabetic cohort of patients undergoing CABG. In animal models, diabetic myocardium is known to possess higher threshold for preconditioning, albeit still possible to precondition. As diabetic patients, are more vulnerable for myocardial injury during CABG and also tolerate the injury relatively poorly compared to their non diabetic counterparts, it is important to explore for cardioprotective strategies to be applied to this high risk diabetic population. The two clinical studies in this thesis evaluate the effect of remote ischemic preconditioning in a) reducing peri-procedural myocardial injury in patients with NSTEACS undergoing urgent percutaneous intervention and b) reducing peri-operative myocardial injury in type 2 diabetic patients undergoing coronary artery bypass surgery.
Effect Of Remote Ischaemic Preconditioning On Clinical Outcomes In Patients Undergoing Coronary Artery Bypass Graft Surgery Ericca Study
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Author :
language : en
Publisher:
Release Date : 2016
Effect Of Remote Ischaemic Preconditioning On Clinical Outcomes In Patients Undergoing Coronary Artery Bypass Graft Surgery Ericca Study written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2016 with categories.
Application Of Remote Ischaemic Preconditioning To Human Coronary Artery Bypass Surgery
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Author : Ishtiaq Ali Rahman
language : en
Publisher:
Release Date : 2010
Application Of Remote Ischaemic Preconditioning To Human Coronary Artery Bypass Surgery written by Ishtiaq Ali Rahman and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2010 with categories.
Effect Of Remote Ischaemic Preconditioning On Clinical Outcomes In Patients Undergoing Coronary Artery Bypass Graft Surgery Ericca Study A Multicentre Double Blind Randomised Controlled Clinical Tr
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Author :
language : en
Publisher:
Release Date : 2016
Effect Of Remote Ischaemic Preconditioning On Clinical Outcomes In Patients Undergoing Coronary Artery Bypass Graft Surgery Ericca Study A Multicentre Double Blind Randomised Controlled Clinical Tr written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2016 with categories.
Myocardial Protection
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Author : Tomas A. Salerno
language : en
Publisher: John Wiley & Sons
Release Date : 2008-04-15
Myocardial Protection written by Tomas A. Salerno and has been published by John Wiley & Sons this book supported file pdf, txt, epub, kindle and other format this book has been release on 2008-04-15 with Medical categories.
Myocardial protection is regarded as one of the most important, yet also most controversial aspects of cardiac surgery. There has been considerable improvement in myocardial protection strategies over recent years, utilising a variety of new approaches to treat cardiac diseases, and this text is intended to embrace the state of the art in this field. The book summarises the state of knowledge on all aspects of myocardial protection, including the latest in the treatment of cardiac diseases, robotics, pediatric surgery and the treatment of cardiac failure. Robotic surgery, valvular surgery, pediatric surgery and coronary surgery are all covered by renowned experts, producing a comprehensive, forward-looking view of the field of myocardial protection. This book should function to update physicians and surgeons interested in the field of cardiac surgery on the current state of knowledge on myocardial protection.
Remote Ischaemic Preconditioning In Coronary Artery Bypass Graft Surgery
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Author :
language : en
Publisher:
Release Date : 2010
Remote Ischaemic Preconditioning In Coronary Artery Bypass Graft Surgery written by and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2010 with categories.
The Effect Of Remote Ischaemic Conditioning And Glyceryl Trinitrate On Perioperative Myocardial Injury In Cardiac Bypass Surgery Patients
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Author : Ashraf Atef Jiries Hamarneh
language : en
Publisher:
Release Date : 2019
The Effect Of Remote Ischaemic Conditioning And Glyceryl Trinitrate On Perioperative Myocardial Injury In Cardiac Bypass Surgery Patients written by Ashraf Atef Jiries Hamarneh and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019 with categories.
BACKGROUND: Due to the aging population and increased prevalence of co-morbidities (such as diabetes, obesity and renal failure), higher risk patients are undergoing coronary artery bypass graft and/or valve (CABG±valve) surgery, increasing the risk of post-surgical complications (such as perioperative myocardial injury/infarction), and worse clinical outcomes. As such, novel cardioprotective strategies are required to protect the heart against perioperative myocardial injury (PMI) during CABG±valve surgery. A number of clinical studies have shown that remote ischaemic preconditioning (RIPC), in which the arm or leg is subjected to cycles of brief ischaemia and reperfusion, by inflating a cuff placed on the upper arm or thigh, can reduce peri-operative myocardial injury (PMI) during CABG±valve surgery. However, not all studies have been positive, and large clinical outcomes studies (ERICCA and RIPHeart) have reported no benefit with RIPC in this clinical setting. The reasons for this are unclear but may relate to co-medications used in this clinical setting including agents such as propofol anaesthesia, and morphine. In this thesis, I investigated whether glyceryl trinitrate (GTN), which is often given as an intra-operative intravenous (IV) infusion, is cardioprotective in its own right, and whether it attenuates the cardioprotective effect of RIPC in patients undergoing CABG±valve surgery. Primary hypothesis: The effect of RIPC on reducing PMI will be attenuated in the presence of GTN administered as an intra-operative IV infusion in patients undergoing CABG±valve surgery. Secondary hypothesis: GTN administered as an intra-operative IV infusion will reduce PMI in patients undergoing CABG±valve surgery. METHODOLOGY : The ERIC-GTN trial (http://www.clinicaltrials.gov: NCT01864252) was a single-site, double-blinded, randomised, placebo-controlled clinical study investigating whether an intra-operative IV GTN infusion attenuates the cardioprotective effect of RIPC in patients undergoing CABG±valve surgery. Consenting adult patients (age >18 years) undergoing elective CABG±valve surgery with blood cardioplegia were eligible for inclusion. Following anaesthetic induction, patients were randomised to receive one of the four treatment groups: Group 1 - Sham+Saline: a sham RIPC protocol (comprising simulated limb cuff inflations and deflations) followed by an intra-operative intravenous (IV) saline infusion. Group 2 - Sham+GTN: a sham RIPC protocol followed by an intra-operative IV GTN infusion. Group 3 - RIPC+Saline: a RIPC protocol (comprising three 5-minute cycles of simultaneous upper arm and thigh cuff inflations/deflations) followed by an intra-operative IV saline infusion. Group 4 - RIPC+GTN: a RIPC protocol followed by an intra-operative IV GTN infusion. The primary endpoint was PMI, as quantified by 72 hour area-under-the-curve (AUC) serum high-sensitivity Troponin T. RESULTS : The intended sample size was 260 patients, but following the results of an interim analysis of 189 patients, the ERIC-GTN trial was stopped. There was no difference in PMI in patients from Groups 1 (Sham+Saline) and 2 (Sham+GTN), suggesting that, in itself, an intra-operative GTN infusion was not cardioprotective. However, patients in Group 3 (RIPC+Saline) did sustain less PMI as evidenced by a 37% reduction in 72 hour AUC Troponin T release, when compared to patients in Group 1 (Sham+Saline), confirming the cardioprotective effects of RIPC. Interestingly, the beneficial effect of RIPC on reducing PMI in Group 3 (RIPC+Saline), was abrogated in the presence of GTN (Group 4, RIPC+GTN), suggesting a negative interaction between RIPC and intra-operative IV GTN infusion. CONCLUSIONS: The interim analysis of the ERIC-GTN study has shown a negative interaction between RIC and GTN, suggesting that an intra-operative GTN infusion, attenuated the cardioprotective effects of GTN, in terms of reducing PMI in patients undergoing CABG±valve surgery. This finding may, in part, explain the results of the ERICCA trial in which RIPC failed to reduce major adverse cardiovascular events in patients undergoing CABG±valve surgery.
The Effect Of Remote Ischaemic Conditioning And Glyceryl Trinitrate On Perioperative Myocardial Injury In Cardiac Bypass Surgery Patients
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Author : Ashraf Atef Jiries Hamarneh
language : en
Publisher:
Release Date : 2019
The Effect Of Remote Ischaemic Conditioning And Glyceryl Trinitrate On Perioperative Myocardial Injury In Cardiac Bypass Surgery Patients written by Ashraf Atef Jiries Hamarneh and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2019 with categories.