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. 2018 Nov 10;5(2):e000891.
doi: 10.1136/openhrt-2018-000891. eCollection 2018.

Intermittent systemic hypoxic-hyperoxic training for myocardial protection in patients undergoing coronary artery bypass surgery: first results from a single-centre, randomised controlled trial

Denis S Tuter  1 , Philippe Y Kopylov  1 , Abram L Syrkin  1 , Oleg S Glazachev  1 , Roman N Komarov  1 , Andrei I Katkov  1 , Ljudmila P Severova  1 , Ekaterina V Ivanova  1 , Young Zhang  2 , Hugo Saner  1   3
Affiliations

Intermittent systemic hypoxic-hyperoxic training for myocardial protection in patients undergoing coronary artery bypass surgery: first results from a single-centre, randomised controlled trial

Denis S Tuter et al. Open Heart. .

Abstract

Background: Although remote ischaemic preconditioning (RIP) provides protection against myocardial ischaemia and reperfusion injury during cardiac surgery, it is not widely used. Systemic intermittent hypoxic-hyperoxic training (IHHT) may be a suitable alternative.

Methods: This is a prospective, single-centre, randomised controlled trial. 127 patients with ischaemic heart disease and indication for coronary artery bypass graft (CABG) surgery from the Cardiology Clinic IM Sechenov First Moscow State Medical University were randomly assigned to IHHT, IHHT-control or RIP. Primary endpoint was serum concentration of troponin I and lactate 2 and 24 hours after surgery.

Results: Median value for troponin I 24 hours after surgery was 1.068 (0.388-1.397) ng/mL in the IHHT group and was significantly lower compared with IHHT-controls with 1.980 (1.068-3.239) ng/mL (p=0.012) and to the RIP group with 1.762 (1.288-2.186) ng/mL (p=0.029), while there was no significant difference between RIP and the IHHT-control. Serum lactate after surgery was 1.74 (1.23-2.04) mmol/L in the IHHT group and was also significantly lower compared with IHHT-controls with 2.10 (1.80-2.29) mmol/L (p=0.045) and RIP with 2.12 (1.91-2.33) mmol/L (p=0.032). No significant complications or serious adverse events were observed during IHHT. Intraoperative and early postoperative complications did not differ significantly between groups.

Conclusions: The results of this first trial using IHHT for myocardial protection against perioperative ischaemic myocardial injury in patients undergoing CABG surgery are promising and further larger trials should be done with adequate power to detect clinical rather than surrogate marker benefits.

Keywords: coronary artery bypass surgery; hypoxic-hyperoxic training; myocardial injury; myocardial protection; remote ischemic preconditioning.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Trial profile. CPB, cardiopulmonary bypass; IHHT, intermittent hypoxic–hyperoxic training; PVD, peripheral vessel disease; RIP, remote ischaemic preconditioning.
figure 2
figure 2
Median values for troponin I and lactate before, 2 and 24 hours after surgery in patients with intermittent hypoxic–hyperoxoc training (IHHT), remote ischaemic preconditioning (RIP) and IHHT-controls.
See this image and copyright information in PMC

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