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Published on: December 11, 2017
Effects of ischaemic postconditioning in aortic valve replacement: a multicenter randomized controlled trial
Mari-Liis Kaljusto1, Andrey Bautin2, Øyvind Jakobsen3
1Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway.
Insights
Ischaemic postconditioning (IPost) did not show overall cardioprotective effects in patients undergoing aortic valve replacement. However, IPost improved cardiac performance in men compared to women post-surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Ischemic Conditioning
Background:
- The cardioprotective effects of ischemic postconditioning (IPost) following cardioplegia are not well-established.
- Investigating IPost's impact on cardiac function after aortic valve replacement is crucial for clinical practice.
Purpose of the Study:
- To evaluate the cardioprotective efficacy of IPost in adult patients undergoing elective aortic valve replacement.
- To assess the impact of IPost on hemodynamic parameters, cardiomyocyte injury biomarkers, renal function, and arrhythmias.
Main Methods:
- A multicenter, prospective, randomized trial involving 209 patients undergoing elective aortic valve replacement.
- Patients were randomized to either standard operation (control) or IPost, involving 3 cycles of normothermic blood flow/non-flow before cross-clamp release.
- Primary endpoint was cardiac index; secondary endpoints included hemodynamic measurements, injury biomarkers, renal function, arrhythmias, and inotropic agent use.
Main Results:
- No significant difference in cardiac index or other hemodynamic parameters between IPost and control groups.
- IPost did not alter troponin T or creatine kinase MB levels, indicating no difference in cardiomyocyte injury.
- IPost significantly reduced the combined risk of postoperative atrial fibrillation and intraoperative ventricular fibrillation by 45% (P=0.03).
- Subgroup analyses showed no differences based on diabetes status, age, or study center.
- However, IPost led to higher cardiac index, cardiac output, mean arterial pressure, and left ventricular stroke work index in males compared to females.
Conclusions:
- Ischemic postconditioning (IPost) demonstrated no overall cardioprotective effect in patients undergoing aortic valve replacement.
- IPost was associated with a significant reduction in arrhythmias.
- Postoperative cardiac performance was notably improved in men compared to women following IPost.
Objectives:
The effect of ischaemic postconditioning (IPost) on postcardioplegic cardiac function is not known. We hypothesized that IPost was cardioprotective in adult patients undergoing elective aortic valve replacement.
Methods:
In a multicentre, prospective, randomized trial, patients (n = 209) were randomized to either a standard operation (controls) or postconditioning. Immediately before the cross-clamp was released, patients in the postconditioning group underwent 3 cycles of flow/non-flow (2 min each) of normothermic blood via the antegrade cardioplegia line. The primary end point was cardiac index. Secondary end points included additional haemodynamic measurements, biomarkers of cardiomyocyte injury, renal function parameters, intra- and postoperative arrhythmias and use of inotropic agents.
Results:
There was no significant difference between the groups regarding cardiac index [mean between-group difference, 95% confidence interval (CI), 0.11 (-0.1 to 0.3), P = 0.27]. Postconditioning had no effect on other haemodynamic parametres. There was no between-group difference regarding troponin T or creatine kinase MB. Postconditioning reduced the relative risk for arrhythmias by 45% (P = 0.03) when postoperative atrial fibrillation and intraoperative ventricular fibrillation were combined. There were no differences in patients with/without diabetes, patients above/below 70 years of age or between the centres. However, after postconditioning, the cardiac index [95% CI, 0.46 (0.2-0.7), P = 0.001], cardiac output (P < 0.001), mean arterial pressure (P < 0.001) and left ventricular stroke work index (P < 0.001) were higher in males compared to females.
Conclusions:
IPost had no overall cardioprotective effects in patients undergoing aortic valve replacement but improved postoperative cardiac performance in men compared to women.
