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Published on: December 11, 2017
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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.
Summary
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.
