medigraphic.com
ISSN 1726-6718 (Electronic)
Revista Cubana de Anestesiología y Reanimación

2013, Number 2

<< Back Next >>

Revista Cubana de Anestesiología y Reanimación 2013; 12 (2)

Economic impact of remote ischemic preconditioning on myocardial revascularization

Hernández OR,González AO, Vázquez RFJ, Hidalgo MPA, Manuel RJ, Nazco HO

Language: Spanish
References: 17
Page: 108-115
PDF size: 60.68 Kb.


ABSTRACT

Background: to condition the heart to improve its endogenous cardioprotective capacity using brief remote ischemia provides a novel potential approach to myocardial protection during cardiac surgery.
Objective: to identify the economic impact of remote ischemic preconditioning in surgically revascularized patients.
Methods: an experimental prospective longitudinal study was conducted in two groups of 100 people who underwent revascularization by coronary artery graft. A tourniquet was placed on the non-dominant arm in those who were included in the test study group, alternating three insufflations with three desinsufflations with a pressure of 200 mmHg, each one being maintained for five minutes. This procedure was performed prior to, during and after the greater ischemic event that corresponds to the pinching of the coronary artery.
Results: an important decrease of the consumption of inotropic, vasoactive and other drugs was achieved, saving an important sum, decreasing hospital costs, and also proving a reduction in the incidence of lethal ventricular arrhythmias, low cardiac output and postoperative death which were, in all cases, below the prediction previously made for these complications.
Conclusions: remote ischemic preconditioning can be an important tool to be considered in the antischemic protection of myocardial revascularization that can diminish morbimortality and hospital costs.


REFERENCES

  1. Don Poldermans, Sanne E. Hoeks, Harm H. Feringa. Pre-Operative Risk Assessment and Risk Reduction Before Surgery. J. Am.Coll. Cardiol. [Internet] 2008 [citado 2009 octubre 1]; 51 (20): 1913-1924 [aprox. 14 p.], Disponible en: http://content.onlinejacc.org/cgi/content /full/51/20/1913.

  2. Przyklenk K, Bauer B, Ovize M, Kloner R, Whittaker P. Regional ischemic `preconditioning' protects remote virgin myocardium from subsequent sustained coronary occlusion. Circulation [Internet]. 1993 [citado 2011 enero 4];87(3):893-9 Disponible en: http://circ.ahajournals.org/content/87/3/893.full.pdf+html .

  3. Hong DM, Jeon Y, Lee CS, Kim HJ, Lee JM, Bahk JH, et al. Effects of remote ischemic preconditioning with postconditioning in patients undergoing off-pump coronary artery bypass surgery—randomized controlled trial. Circ J [Internet]. 2012 [citado 2012 Sep 27];76(4):884-90; Disponible en: http://dx.doi.org/10.1253/circj.CJ-11-068 .

  4. Hausenloy DJ, Candilio L, Laing C, Kunst G, Pepper J, Kolvekar S, et al. Effect of remote ischemic preconditioning on clinical outcomes in patients undergoing coronary artery bypass graft surgery (ERICCA): rationale and study design of a multi-centre randomized double-blinded controlled clinical trial. Clin Res Cardiol [Internet]. 2012 May, [citado 2012 Sep 27];101(5):339-48; Disponible en: http://dx.doi.org/10.1007/s00392-011-0397-x .

  5. Balakumar P, Sharma NK. Healing the diabetic heart: does myocardial preconditioning work? Cell Signal [Internet]. 2012 Ene, [citado 2012 Sep 27];24(1):53-9; Disponible en: http://dx.doi.org/10.1016/j.cellsig.2011.09.007 .

  6. Cai ZP, Parajuli N, Zheng X, Becker L. Remote ischemic preconditioning confers late protection against myocardial ischemia-reperfusion injury in mice by upregulating interleukin-10. Basic Res Cardiol [Internet]. 2012 Jul, [citado 2012 Sep. 27];107(4):277; Disponible en: http://dx.doi.org/10.1007/s00395-012-0277-1 .

  7. Heusch G, Musiolik J, Kottenberg E, Peters J, Jakob H, Thielmann M. STAT5 Activation and Cardioprotection by Remote Ischemic Preconditioning in Humans. Circ Res [Internet]. 2012 Ene 6, [citado 2012 Sep. 27];110(1):111-5; Disponible en: http://dx.doi.org/10.1161/CIRCRESAHA.111.259556 .

  8. Hong DM, Jeon Y, Lee CS, Kim HJ, Lee JM, Bahk JH, et al. Effects of remote ischemic preconditioning with postconditioning in patients undergoing off-pump coronary artery bypass surgery—randomized controlled trial. Circ J [Internet]. 2012 [citado 2012 Sep 27];76(4):884-90; Disponible en: http://dx.doi.org/10.1253/circj.CJ-11-068 .

  9. Veighey K, Macallister RJ. Clinical applications of remote ischemic preconditioning. Cardiol Res Pract [Internet]. 2012 [citado 2012 Sep 27];2012:620681; Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286899/pdf/CRP2012-620681.pdf .

  10. Liang CL, Lu K, Liliang PC, Chen TB, Chan SH, Chen HJ. Ischemic preconditioning ameliorates spinal cord ischemia-reperfusion injury by triggering autoregulation. J Vasc Surg [Internet]. 2012 Abr, [citado 2012 Sep 27];55(4):1116-23; Disponible en: http://dx.doi.org/10.016/j.jvs.2011.09.096 .

  11. Maretta M, Toth S, Bujdos M, Toth S Jr., Jonecova Z, Vesela J. Alterations of epithelial layer after ischemic preconditioning of small intestine in rats. J Mol Histol [Internet]. 2012 Abr, [citado 2012 Sep 27];43(2):171-8; Disponible en: http://dx.doi.org/10.1007/s10735-012-9393 -3.

  12. Winbladh A, Bjornsson B, Trulsson L, Offenbartl K, Gullstrand P, Sandstrom P. Ischemic preconditioning prior to intermittent Pringle maneuver in liver resections. J Hepatobiliary Pancreat Sci. 2012 Mar, [citado 2012 Sep 27];19(2):159-70; Disponible en: http://dx.doi.org/10.1007/s00534-011-0402-9.

  13. Yang NY, Shi L, Zhang Y, Ding C, Cong X, Fu FY, et al. Ischemic preconditioning reduces transplanted submandibular gland injury. J Surg Res [Internet]. 2012 Mar 19, [citado 2012 Sep 27];[publicado en línea con antelación]:[aprox. 12 pp.]; Disponible en: http://dx.doi.org/0.1016/j.jss.2012.02.066 .

  14. Alreja G, Bugano D, Lotfi A. Effect of remote ischemic preconditioning on myocardial and renal injury: meta-analysis of randomized controlled trials. J Invasive Cardiol [Internet]. 2012 Feb, [citado 2012 Sep. 27];24(2):42-8; Disponible en: http://www.invasivecardiology.com/ .

  15. Thielmann M. Remote ischemic preconditioning in cardiac surgery: caught between clinical relevance and statistical significance? Basic Res Cardiol [Internet]. 2012 May, [citado 2012 Sep 27];107(3):1-4; Disponible en: http://dx.doi.org/10.1007/s00395-012-0259-3 .

  16. Hogan AR, Doni M, Molano RD, Ribeiro MM, Szeto A, Cobianchi L, et al. Beneficial Effects of Ischemic Preconditioning on Pancreas Cold Preservation. Cell Transplant [Internet]. 2012 Feb 2, [citado 2012 Sep 27];[Publicado en línea con antelación]:[Aprox. 20 pp.]; Disponible en: http//dx.doi.org/10.3727/096368911X623853.

  17. Abu-Amara M, Yang SY, Quaglia A, Rowley P, Tapuria N, Fuller B, et al. The hepatic soluble guanylyl cyclase-cyclic guanosine monophosphate pathway mediates the protection of remote ischemic preconditioning on the microcirculation in liver ischemia-reperfusion injury. Transplantation [Internet]. 2012 May 15, [citado 2012 Sep 27];93(9):880-6; Disponible en: http://dx.doi.org/10.1097/TP.0b013e31824cd59d.




2020     |     www.medigraphic.com