Investigating the effect of remote ischaemic preconditioning on biomarkers of stress and injury-related signalling in patients having isolated coronary artery bypass grafting or aortic valve replacement using cardiopulmonary bypasReportar como inadecuado




Investigating the effect of remote ischaemic preconditioning on biomarkers of stress and injury-related signalling in patients having isolated coronary artery bypass grafting or aortic valve replacement using cardiopulmonary bypas - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Trials

, 16:181

First Online: 23 April 2015Received: 27 October 2014Accepted: 30 March 2015DOI: 10.1186-s13063-015-0696-z

Cite this article as: Fiorentino, F., Angelini, G.D., Suleiman, MS. et al. Trials 2015 16: 181. doi:10.1186-s13063-015-0696-z

Abstract

BackgroundIschaemia-reperfusion injury occurs during heart surgery that uses cardiopulmonary bypass CPB and cardioplegic arrest. It is hypothesised that remote ischaemic preconditioning RIPC protects the heart against such injury. Despite the numerous studies investigating the protective effects of RIPC, there is still uncertainty about the interpretation of the findings as well as conflicting results between studies. The objective of this trial is to investigate the cardioprotective effect of RIPC in patients having coronary artery bypass grafting CABG or aortic valve replacement surgery. This will be achieved by estimating the effect of the intervention in the two groups of pathologies and by investigating the signalling mechanisms that may underpin the cardioprotective effect.

Methods-DesignA two-centre randomised controlled trial will be used to investigate the effects of RIPC in two pathologies: patients having isolated CABG and those having aortic valve replacement surgery AVR with CPB. Participants will be randomised to RIPC or control sham RIPC, stratified by surgical stratum. The intervention will be delivered by a research nurse. Data will be collected by a research nurse blinded to the intervention. The patient and the theatre staff are also blinded to the allocation. Markers of myocardial injury and inflammation will be measured in myocardial biopsies and in blood samples at different times.

DiscussionThis trial is designed to investigate whether RIPC will reduce myocardial injury and inflammation following heart surgery and whether there is a difference in effect between participants having CABG or AVR. This trial is a unique opportunity to study the mechanisms associated with RIPC using human myocardial tissue and blood, and to relate these to the extent of myocardial injury-protection.

Trial registrationCurrent Controlled Trials ISRCTN33084113 25 March 2013.

KeywordsCoronary artery bypass graft surgery Aortic valve surgery Remote ischaemic preconditioning Ischemia Reperfusion Randomised controlled clinical trial AbbreviationsADPadenosine diphosphate

AMPadenosine monophosphate

ATPadenosine 5’ triphosphate

AVRaortic valve replacement-repair

CABGcoronary artery bypass grafting

CPBcardiopulmonary bypass

CRFcase report form

GFRglomerular filtration rate

EIAenzyme immunoassay

ELISAenzyme-linked immunosorbent assay

Erkextracellular signal-regulated kinases

IABPintra-aortic ballon pump

ICHTImperial College Healthcare NHS Trust

ICUintensive care unit

IL-6interleukin-6

IL-8interleukin-8

IL-10interleukin-10

IMPinosine 5’-monophosphate

JNKc-Jun N-terminal kinases

MDAmalondialdehyde

MPTPmitochondrial permeability transition pore

mRNAmessenger ribonucleic acid

NAD+nicotinamide adenine dinucleotide

P38MAPKP38 mitogen-activated protein kinases

PCIpercutaneous coronary intervention

PI3Kphosphoinositide 3-kinase inhibitor

PISpatient information sheet

RIPCremote ischaemic preconditioning

RECresearch ethics committee

RISKreperfusion injury salvage kinase

SAEserious adverse event

STAT5transcription 5

TNFαmtumor factor necrosis α

UH BristolUniversity Hospitals of Bristol NHS Foundation Trust

Electronic supplementary materialThe online version of this article doi:10.1186-s13063-015-0696-z contains supplementary material, which is available to authorized users.

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Autor: Francesca Fiorentino - Gianni D Angelini - M-Saadeh Suleiman - Alima Rahman - Jon Anderson - Alan J Bryan - Lucy A Culli

Fuente: https://link.springer.com/







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