Le préconditionnement ischémique à distance en chirurgie de remplacement valvulaire aortique isolé : évaluation de l'effet cardioprotecteur
|Advisor:||Voisine, Pierre; Douville, Yvan|
|Abstract:||BACKGROUND : Perioperative myocardial injury is associated with a significant increase in cardiovascular morbidity and mortality in the cardiac surgery population. The use of remote ischemic preconditioning (RIPC) could help preventing myocardial injury. We studied the effect of RIPC in patients undergoing isolated aortic valve replacement surgery. METHODS : Between May 2014 and June 2018, in a tertiary care center (Institut universitaire de cardiologie et de pneumologie de Québec, [IUCPQ], Quebec, Canada), 81 patients were randomized in a double blind fashion to RIPC or control group. RIPC was performed using a pressure cuff either only on the right upper extremity or on both the right upper and lower extremities. Primary outcome was defined as post-operative elevation of cardiac enzymes. RESULTS : Patients were predominantly male (58%) with a mean age of 68.7 years. Baseline characteristics of both groups were similar except for NYHA functional class. There were no significant differences in the postoperative levels of troponins HS T and CK-MB in the RIPC group when compared to the control group (p>0.05). In subgroup analysis, the use of multiple sites RIPC did not show a difference in troponins HS T levels when compared to the use of a single site RIPC or control group (p>0.05). RIPC was not associated with a reduction in postoperative all-cause mortality (p=1.0). RIPC did not influence cardiac function (p=0.9) or physical activity tolerance (NYHA p=0.09; CCS p=0.05) at 3 months follow-up. CONCLUSION : RIPC has not demonstrated a cardioprotective effect during aortic valve replacement surgery. Larger multicenter randomized controlled trials are needed to further investigate the potential cardioprotective effect of RIPC.|
|Document Type:||Mémoire de maîtrise|
|Open Access Date:||11 December 2019|
|Collection:||Thèses et mémoires|
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