[Effects of remote ischemic preconditioning on perioperative period in elective aortic valve replacement].

PURPOSE OF THE STUDY: To evaluate the effects of remote ischemic preconditioning (RIPC) on the perioperative period in elective aortic valve replacement (AVR) along different anaesthesia techniques. MATERIALS AND METHODS: 48 patients aged 50 to 75 years (64 (56;69)) which were scheduled for AVR due to aortic valve stenosis were included into the prospective, randomized study. Four groups were formed after randomization: 1) RIPC applied during propofol anesthesia (RIPCprop, n = 12), 2) RIPC applied during sevoflurane anesthesia (RIPCsevo, n = 12), 3) propofol anesthesia without RIPC (CONTROLprop, n = 12), 4) sevoflurane anesthesia without RIPC (CONTROLsevo, n = 12). Groups were similar in baseline data of patients. RIPC protocol: three five-minutes episodes of simultaneous both lower limbs ischemia with five-minutes reperfusion intervals. Troponin I (cTrI), interleukin-6 (IL-6), Interleukin-8 (IL-8) and C-reactive protein (CRP) levels were assessed prior to induction of anesthesia, at 30 min, 6, 12, 24 and 48 hours after the cessation of CPB. Significant differences were assessed by the nonparametric Mann-Whitney and Fisher's exact tests. Data are presented as: median (25th percentile, 75th percentile). RESULTS: . Significant differences in cTnI were found between RIPCsevo and CONTROLsevo groups at 6, 12 and 24 hours: 1.68 (1.28, 2.09) ng/ml vs 3.66 (2.07, 4.49) ng/ml, respectively at 6 hours (p = 0.04); 1.89 (1.59, 2.36) ng/ml vs 3.66 (2.91, 5.64) ng/ml, respectively at 12 hours (p = 0.001); 1.68 (1.55; 2.23) ng/ml vs 3.32 (2.10; 5.46) ng/ml, respectively at 24 hours (p = 0.01). There were no differences found in cTnI between RIPCprop and CONTROLprop groups during the whole study. There were no significant differences found in the levels of IL-6 and CRP between RIPC and control groups during the whole study Unexpectedly significant excess concentrations of IL-8 at 24 h were found when RIPC applied during sevoflurane anesthesia: 12.3 (10.6, 14.4) pg/mL in RIPCsevo group vs 6.2 (4.8, 11.1) pg/ml in CONTROLsevo group (p = 0.02). There was no paroxysmal atrial fibrillation (AF) after RIPC, and 5 cases were registered in the control groups (p = 0.02). No other significant differences in the clinical course of the postoperative period were found. CONCLUSIONS: Cardioprotective effect of RIPC and its effect on systemic inflammatory response should be assessed in the selected anesthesia groups. RIPC on the background of sevoflurane anesthesia reduces myocardial injury during AVR. RIPC does not reduce the severity of the systemic inflammatory response after AVR. RIPC reduces the risk of AF after AVR.

[Early postoperative hyperlactatemia in patients after surgery under extracorporeal circulation].

Metabolic disturbances, such as changes in blood acid-base balance and electrolytic composition; hyperglycemia and hyperlactatemia, are frequent factors that complicate the early postoperative period in patients after cardiac surgery under extracorporeal circulation. The purpose of the study was to estimate the incidence of hyperlactatemia in the early postoperative period and to reveal the predictors of its occurrence. This prospective study was conducted in our center from November 14, 2006, to September 1, 2007. The study covered 270 patients above 15 years of age, who had been operated on for coronary heart disease, acquired heart diseases, and combined lesions of valves and coronary arteries. Hyperlactatemia was observed in a substantial proportion of patients who had been operated on under extracorporeal circulation. Correlation analysis indicated a significant association between the duration of extracorporeal circulation and the magnitude of hyperlactatemia developing in the early postoperative period. Hyperglycemia with a glucose level of > 9 mmol/l is a predictor of the development of hyperglycemia.

[Clinical experience with voluven solution used as a basic component for pump oxygenator filling during operations on the cardiac valves and coronary arteries].

The present study comparatively analyzed the clinical effects of three solutions used to fill an extracorporeal circulatory circuit (ECCC). The arterial and venous blood samples taken from patients operated on for valvular disease and coronary heart disease were studied. All patients (n = 61) were divided into 3 groups according to the basic component of the primary volume of ECCC filling: 1) Ringer's crystalloid solution; 2) gelofusin; 3) the hydroxyethyl starch 130/0.4 Voluven. The resultant samples were examined for the following parameters: a) hematological: the levels of formed blood elements, hemoglobin, erythrocytic hemoglobin, and free hemoglobin and the histograms of leukocytes, erythrocytes, and platelets; b) physicochemical: arterial and venous blood pH, pO2, pCO2, SatO2; c) biochemical: blood electrolytic balance and lactate levels. The values of hemoglobin, hematocrit, and blood gas composition were used to calculate oxygen consumption (ml/min x m2). The parameters of central hemodynamics and the temperatures in the rectum, esophagus, and venous oxygenator port were continuously monitored during extracorporeal circulation (EC). At its end, overall diuresis and water balance were determined. The plasma-substituting effect of Voluven was found to be highly effective during a clinical study. The found beneficial properties of the agent may be particularly attractive while applying EC to the surgery of acquired heat diseases when the duration of an operation and, accordingly, extracorporeal support forces the physician to administer large solution doses many times.

[Evaluation of the safety of auxiliary venous drainage in the surgical treatment of patients with acquired cardiac diseases].

The present study has comparatively analyzed two procedures of auxiliary venous drainage: 1) that by means of vacuum (VaVD), 2) that using an additional roller pump (ARP) and the conventional extracorporeal circulation (EC) with gravitation venous drainage (GVD). The material for the study was the number of microembolic signals (MES) in the middle cerebral artery bed and neurological disorders in patients operated on for cardiac valvular diseases. According to the venous drainage procedure, the patients (n = 90) were divided into 3 groups: 1) those (n = 30) with traditional GVD; 2) those (n = 30) with VaVD; 3) those (n = 30) with ARP. The study revealed the impact of different venous drainage procedures on the number of MES and the patients' neurological status.