Journal of cardiovascular medicine
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J Cardiovasc Med (Hagerstown) · Mar 2013
ReviewRemote ischemic preconditioning: the surgeon's perspective.
Since cardiac surgery began, surgeons have aimed to find methods of minimizing myocardial injury resulting from ischemia and reperfusion. The concept of somehow conditioning the heart in order to attenuate ischemia and reperfusion-related injury has evolved in cardiovascular research over decades, from ischemic preconditioning and postconditioning to, more recently, remote ischemic preconditioning (and postconditioning). ⋯ To date, the translation of this powerful innate mechanism of myocardial and/or multiorgan protection from the animal lab to the operating theatre, using transient occlusion of blood flow to the upper limb with a blood-pressure cuff before cardiac surgery, has shown promising results, with several proof-of-principle and first randomized controlled clinical trials reporting benefits for patients undergoing cardiac surgery. If the efficacy of remote ischemic preconditioning can be conclusively proven, the clinical applications in cardiac surgery could be almost infinite, providing multiorgan protection in various surgical scenarios.
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J Cardiovasc Med (Hagerstown) · Mar 2013
Review Historical ArticleGenesis of remote conditioning: action at a distance--'hypotheses non fingo'?
Remote ischemic preconditioning is the phenomenon whereby brief episodes of ischemia-reperfusion applied in a distant organ or tissue render the myocardium resistant to infarction. The discovery of remote conditioning was not a serendipitous finding, but, rather, was predicted by mathematical modeling. In the current review, we describe how the hypothesis for remote conditioning was formulated and tested, how the paradigm has expanded to encompass a spectrum of remote triggers, and summarize the progress that has been made in elucidating the mechanisms responsible for this intriguing form of cardioprotection.
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J Cardiovasc Med (Hagerstown) · Feb 2013
Review Meta Analysisn-3 Polyunsaturated fatty acids for the prevention of postoperative atrial fibrillation: a meta-analysis of randomized controlled trials.
n-3 Polyunsaturated fatty acids (n-3 PUFAs) have been proposed as prophylactic therapy in the prevention of postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery. We conducted a meta-analysis of randomized controlled trials to better clarify this issue. ⋯ In conclusion, the results of the present meta-analysis of randomized controlled trials suggest that preoperative n-3 PUFA therapy may not reduce POAF in patients undergoing cardiac surgery. However, several aspects may have influenced this negative result, which need to be investigated.
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J Cardiovasc Med (Hagerstown) · Feb 2013
EditorialWhat news in the 2010 European Society of Cardiology (ESC) guidelines for the management of grown-up congenital heart disease?
The new guidelines of the European Society of Cardiology (ESC) for the management of grown-up congenital heart disease were published in August 2010 and follow the first guidelines on this subject published by the society in 2003. This article discusses the rational for publishing this document and the difficulties of generating guidelines for this special field in cardiology. ⋯ Compared to previous documents the new guidelines provide more comprehensive information with more precise recommendations and update the knowledge in this field. They should help to improve the quality of care of grown-up congenital heart disease patients.