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Protective effect of remote ischemic pre‑conditioning on patients undergoing cardiac bypass valve replacement surgery: A randomized controlled trial

  • Authors:
    • Xiuling Jin
    • Liangrong Wang
    • Liling Li
    • Xiyue Zhao
  • View Affiliations / Copyright

    Affiliations: Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
    Copyright: © Jin et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Pages: 2099-2106
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    Published online on: January 21, 2019
       https://doi.org/10.3892/etm.2019.7192
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Abstract

Remote ischemic pre‑conditioning (RIPC) may have a protective effect on myocardial injury associated with cardiac bypass surgery (CPB). The objective of the present study was to investigate the effect of RIPC on ischemia/reperfusion (I/R) injury and to assess the underlying mechanisms. A total of 241 patients who underwent valve replacement were randomly assigned to receive either RIPC (n=121) or control group (n=120). The primary endpoint was peri‑operative myocardial injury (PMI), which was determined by serum Highly sensitive cardiac troponin T (hsTnT). The secondary endpoint was the blood gas indexes, acute lung injury and length of intensive care unit stay, length of hospital stay and major adverse cardiovascular events. The results indicated that in comparison with control group, RIPC treatment reduced the levels of hsTnT at 6 and 24 h post‑CPB (P<0.001), as well as the alveolar‑arterial oxygen pressure difference and respiratory index after CPB. Furthermore, RIPC reduced the incidence of acute lung injury by 15.3% (54.1% in the control group vs. 41.3% in the RIPC group, P=0.053). It was indicated that RIPC provided myocardial and pulmonary protection during CPB. In addition, the length of the intensive care unit and hospital stay was reduced by RIPC. Mechanistic investigation revealed a reduced content of soluble intercellular adhesion molecule‑1, endothelin‑1 and malondialdehyde, as well as elevated levels of nitric oxide in the RIPC group compared with those in the control group. This indicated that RIPC protected against I/R injury associated with CPB through reducing the inflammatory response and oxidative damage, as well as improving pulmonary vascular tension. In conclusion, RIPC reduced myocardial and pulmonary injury associated with CPB. This protective effect may be associated with the inhibition of the inflammatory response and oxidative injury. The present study proved the efficiency of this approach in reducing ischemia/reperfusion injury associated with cardiac surgery. Clinical trial registry no. ChiCTR1800015393.
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Copy and paste a formatted citation
Spandidos Publications style
Jin X, Wang L, Li L and Zhao X: Protective effect of remote ischemic pre‑conditioning on patients undergoing cardiac bypass valve replacement surgery: A randomized controlled trial. Exp Ther Med 17: 2099-2106, 2019.
APA
Jin, X., Wang, L., Li, L., & Zhao, X. (2019). Protective effect of remote ischemic pre‑conditioning on patients undergoing cardiac bypass valve replacement surgery: A randomized controlled trial. Experimental and Therapeutic Medicine, 17, 2099-2106. https://doi.org/10.3892/etm.2019.7192
MLA
Jin, X., Wang, L., Li, L., Zhao, X."Protective effect of remote ischemic pre‑conditioning on patients undergoing cardiac bypass valve replacement surgery: A randomized controlled trial". Experimental and Therapeutic Medicine 17.3 (2019): 2099-2106.
Chicago
Jin, X., Wang, L., Li, L., Zhao, X."Protective effect of remote ischemic pre‑conditioning on patients undergoing cardiac bypass valve replacement surgery: A randomized controlled trial". Experimental and Therapeutic Medicine 17, no. 3 (2019): 2099-2106. https://doi.org/10.3892/etm.2019.7192
Copy and paste a formatted citation
x
Spandidos Publications style
Jin X, Wang L, Li L and Zhao X: Protective effect of remote ischemic pre‑conditioning on patients undergoing cardiac bypass valve replacement surgery: A randomized controlled trial. Exp Ther Med 17: 2099-2106, 2019.
APA
Jin, X., Wang, L., Li, L., & Zhao, X. (2019). Protective effect of remote ischemic pre‑conditioning on patients undergoing cardiac bypass valve replacement surgery: A randomized controlled trial. Experimental and Therapeutic Medicine, 17, 2099-2106. https://doi.org/10.3892/etm.2019.7192
MLA
Jin, X., Wang, L., Li, L., Zhao, X."Protective effect of remote ischemic pre‑conditioning on patients undergoing cardiac bypass valve replacement surgery: A randomized controlled trial". Experimental and Therapeutic Medicine 17.3 (2019): 2099-2106.
Chicago
Jin, X., Wang, L., Li, L., Zhao, X."Protective effect of remote ischemic pre‑conditioning on patients undergoing cardiac bypass valve replacement surgery: A randomized controlled trial". Experimental and Therapeutic Medicine 17, no. 3 (2019): 2099-2106. https://doi.org/10.3892/etm.2019.7192
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