Irina A MandelFederal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency, Russian Federation
Title: Endothelial function and hypoxic–hyperoxic preconditioning in coronary surgery
Background: A Hypoxic–Hyperoxic preconditioning (HHP) may be associated with cardioprotection by reducing endothelial damage and a beneficial effect on postoperative outcome in patients undergoing cardiac surgery with Cardiopulmonary Bypass (CPB).
Methods: A prospective, randomized clinical trial includes 120 patients, who were assigned to an HHP and a control group. A safe, inhaled oxygen fraction for the hypoxic preconditioning phase (10–14% oxygen for 10 min) was determined by measuring the anaerobic threshold. At the hyperoxic phase, a 75–80% oxygen fraction was used for 30 min.
Results: The cumulative frequency of postoperative complications was 14 (23.3%) in the HHP vs. 23 (41.1%), p = 0.041. The nitrate decreased after surgery by up to 20% in the HHP group and up to 38% in the control group. Endothelin-1 and nitric oxide metabolites were stable in HHP but remained low for more than 24 h in the control group. The endothelial damage markers appeared to be predictors of postoperative complications.
Conclusion: The HHP with individual parameters based on the anaerobic threshold is a safe procedure, and it can reduce the frequency of postoperative complications. The endothelial damage markers appeared to be predictors of postoperative complications.
Irina A Mandel completed her PhD dedicated to prophylaxis and treatment of gastrointestinal complications in cardiac surgery at the age of 32 years from Meshalkin National Medical Research Center (Novosibirsk, Russia). She is the leading researcher of the anesthesiology and intensive care department of Federal Scientific and Clinical Center. She has 75 publications that have been cited over 100 times. Her main field of interest is cardiovascular anesthesia, myocardial protection against ischemia-reperfusion injury, preconditioning with hypoxic, hyperoxic, nitric oxide gas mixtures, intensive care of cardiac patients.