Endothelial Function and Hypoxic–Hyperoxic Preconditioning in Coronary Surgery with a Cardiopulmonary Bypass: Randomized Clinical Trial
Irina A. Mandel,
Yuriy K. Podoksenov,
Sergey L. Mikheev,
Irina V. Suhodolo,
Yulia S. Svirko,
Vladimir M. Shipulin,
Anastasia V. Ivanova,
Andrey G. Yavorovskiy,
Andrey I. Yaroshetskiy
Affiliations
Irina A. Mandel
Department of Anesthesiology and Intensive Care, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
Yuriy K. Podoksenov
Department of Anesthesiology and Intensive Care, Tomsk National Research Medical Center of the Russian Academy of Sciences, Cardiology Research Institute, 634012 Tomsk, Russia
Sergey L. Mikheev
Department of Cardiovascular Surgery, Tomsk National Research Medical Center of the Russian Academy of Sciences, Cardiology Research Institute, 634012 Tomsk, Russia
Irina V. Suhodolo
Department of Morphology and General Pathology, Siberian State Medical University, 634050 Tomsk, Russia
Yulia S. Svirko
Biochemical Laboratory, Tomsk National Research Medical Center of the Russian Academy of Sciences, Cardiology Research Institute, 634012 Tomsk, Russia
Vladimir M. Shipulin
Department of Hospital Surgery with a Cardiovascular Surgery Course, Siberian State Medical University, 634050 Tomsk, Russia
Anastasia V. Ivanova
General Medicine Faculty, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
Andrey G. Yavorovskiy
Department of Anesthesiology and Intensive Care, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
Andrey I. Yaroshetskiy
Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
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). Patients (n = 120) were randomly 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. 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. 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.
