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Published on: May 28, 2019
The protective effects of preconditioning decline in aged patients undergoing coronary artery bypass grafting
Z K Wu1, E Pehkonen, J Laurikka
1Division of Cardiothoracic Surgery, Department of Anesthesiology and Intensive Care, Tampere University Hospital, University of Tampere, Tampere, Finland.
Insights
Myocardial ischemic preconditioning protects adult hearts during coronary artery bypass grafting, improving recovery. However, this protective effect is diminished in aged patients, showing no significant benefit.
Area of Science:
- Cardiology
- Cardiac Surgery
- Ischemic Heart Disease
Background:
- Myocardial ischemic preconditioning is a phenomenon where brief periods of ischemia followed by reperfusion protect the heart against subsequent longer ischemic insults.
- Coronary artery bypass grafting (CABG) is a major surgical procedure that can lead to myocardial ischemia-reperfusion injury.
Purpose of the Study:
- To investigate the effects of myocardial ischemic preconditioning in adult and aged patients undergoing CABG.
- To compare hemodynamic data and cardiac troponin I values between preconditioned and control groups in different age demographics.
Main Methods:
- Eighty patients with 3-vessel disease undergoing CABG were randomized into adult and aged groups, each with an ischemic preconditioning arm and a control arm.
- Ischemic preconditioning involved two 2-minute periods of ischemia followed by 3 minutes of reperfusion.
- Hemodynamic parameters (right ventricular ejection fraction, cardiac index) and cardiac troponin I levels were measured and analyzed using statistical tests including Student t test, chi(2) test, and ANOVA for repeated measures.
Main Results:
- Ischemic preconditioning significantly improved the recovery of right ventricular ejection fraction and cardiac index in adult patients (P =.013 and.001, respectively).
- In contrast, aged patients showed no significant difference in the recovery of ejection fraction and cardiac index with ischemic preconditioning (P =.232 and.889, respectively).
- Adult patients receiving ischemic preconditioning had lower cardiac troponin I levels (P =.046), shorter postoperative mechanical ventilation time, and reduced inotropic support compared to controls.
Conclusions:
- Myocardial ischemic preconditioning demonstrates a protective effect against ischemia-reperfusion injury in adult patients undergoing CABG.
- The benefits include enhanced recovery of cardiac function and improved surgical outcomes in adults.
- The protective efficacy of ischemic preconditioning is significantly reduced in aged patients undergoing coronary bypass surgery.
Objective:
We sought to investigate the effects of myocardial ischemic preconditioning in adult and aged patients undergoing coronary artery bypass grafting.
Methods:
Eighty patients with 3-vessel disease undergoing coronary artery bypass grafting were randomized into one of the following groups: adult ischemic preconditioning, adult control, aged ischemic preconditioning, and aged control. Hemodynamic data and cardiac troponin I values were compared between the groups. The ischemic preconditioning groups received 2 periods of 2 minutes of ischemia, followed by 3 minutes of reperfusion. The Student t test, chi(2) test, and analysis of variance for repeated measures were used for the statistical analysis.
Results:
The baseline for right ventricular ejection fraction and cardiac index was similar. Right ventricular ejection fraction was depressed after the operation in all groups. Ischemic preconditioning significantly improved the recovery of right ventricular ejection fraction and cardiac index after the operation in adult patients (P =.013 and.001, respectively), but in the aged group there was no difference in the changes of ejection fraction and cardiac index (P =.232 and.889, respectively). The cardiac troponin I value in the adult patients subjected to ischemic preconditioning was lower than that in the adult control subjects (P =.046), but in aged patients undergoing ischemic preconditioning, the value was similar to that in aged control subjects (P =.897). Ischemic preconditioning also resulted in a shorter postoperative mechanical ventilation time and in less inotropic use in the adult group.
Conclusion:
Ischemic preconditioning protects the heart from ischemic reperfusion injury in adult patients undergoing coronary artery bypass grafting. The beneficial effects of ischemic preconditioning are manifested as a better recovery of right ventricular and global hemodynamic function, cellular viability, and surgical outcome. The protective effect of ischemic preconditioning is diminished in aged patients undergoing coronary bypass.
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