EFFICACY OF PHYSICAL TRAININGS AS CARDIOPROTECTION METHOD FOR CORONARY BYPASS SURGERY

Aim. To assess efficacy and safety of inclusion of physical trainings to the program of patients prehabilitation before coronary bypass (CBG) on-pump, from the perspective of cardioprotection.

Material and methods. Totally, 38 patients included, randomized to 2 group depending on prehabilitation program. Group 1 patients (n=20, mean age 57,9±7,2 y. o.) at the stage of prehabilitation, underwent serial physical trainings of high intensity; in group 2 (n=18, mean age 60,4±7,01 y. o.) there were none. Evaluation of the target parameters of myocardial perfusion was done before the training and in post-operation period with single photon emission tomography (SPECT).

Results. In the group with included exercises, during post-surgery period there was significantly higher level of radiopharmacological marker capture comparing to nontrained group in some basal segments (74,9±3,98% and 70,3±7,40%, respectively, р=0,04), middle (86,7±5,24% and 79,6±10,43%, resp., р=0,03) and apical (85,8±5,03% and 79,0±8,67%, resp., р=0,02) portions of myocardium, by SPECT. Integral value of the stress-induced temporary ischemia (SDS) after CBG in training group was significantly lower than in non-training group (0 and 0,9±0,53 pts., resp., р=0,04). Dynamics analysis of the parameters of myocardial perfusion demonstrated significant decrease of the parameter characterizing perfusion defect with adenosin load (SSS) (р=0,013), and SDS (р=0,018) in the group of exercises after operation comparing to pre-operational values. In non-training group the dynamics was nonsignificant.

Conclusion. According to the data obtained, inclusion of physical trainings of high intensity to the program of prehabilitation of patients before CBG leads to improvement of myocardial perfusion parameters in post-operation period, that possibly optimizes the outcomes of surgery.

coronary heart disease, coronary bypass, prehabilitation, ischemic preconditioning, physical training

1. Bokeriya LA, Gudkova RG. Serdechno-sosudistaya khirurgiya-2015. Bolezni i vrozhdennye anomalii sistemy krovoobrashcheniya. M.: Bakoulev SCCS RAMS, 2016. 212 р. (In Russ.) ISBN 978-5-7982-0367-3.

2. Rezende PC, Rahmi RM, Uchida AH, et al. Type 2 diabetes mellitus and myocardial ischemic preconditioning in symptomatic coronary artery disease patients. Cardiovasc Diabetol 2015; 14: 66. DOI: 10.1186/s12933-015-0228-x.

3. Chen C, Chappell D, Annecke T, et al. Sevoflurane mitigates shedding of hyaluronan from the coronary endothelium, also during ischemia/reperfusion: an ex vivo animal study. Hypoxia (Auckl) 2016; 4: 81-90. DOI: 10.2147/HP.S98660.

4. Osipova OA, Suyazova SB, Vlasenko MA, et al. Perioperative myocardial infarction diagnostics after surgial coronary revascularization. Sovremennye problemy nauki i obrazovanija 2012; 3: 44. (In Russ.) https://elibrary.ru/item.asp?id=17822284.

5. Argunova YA, Pomeshkina SA, Inozemtseva AA. Potential benefits of exercise training as a factor of ischemic preconditioning prior to coronary artery bypass grafting (review). Complex Issues of Cardiovascular Diseases 2017; 3: 166-74. (In Russ.) DOI: 10.17802/2306-1278-2017-6-3-166-174.

6. Sawatzky JA, Kehler DS, Ready AE, et al. Prehabilitation program for elective coronary artery bypass graft surgery patients: a pilot randomized controlled study. Clin Rehabil 2014; 28 (7): 648-57. DOI: 10.1177/0269215513516475.

7. Полтавская М. Г., Мкртумян Э. А., Свет А. В. и др. Нагрузочные пробы с газовым анализом: пособие для врачей общей практики. М: Московская медицинская академия имени И. М. Сеченова, 2009, 40 с.

8. Ferguson B. ACSM’s Guidelines for Exercise Testing and Prescription 9th Ed. 2014.The Journal of the Canadian Chiropractic Association 2014; 58 (3): 328.

9. Bautin AE, Karpova LI, Marichev AO, et al. Cardioprotective effects of ischemic conditioning. Up-to-date information in physiology, experimental evidences and clinical applications. Transljacionnaja medicina = Translational Medicine 2016; 3 (1): 50-62. (In Russ.) https://elibrary.ru/item.asp?id=27374664.

10. Heusch G, Botker H, Przyklenk K, et al. Remote ischemic conditioning. J Am Coll Cardiol 2015; 65 (2): 177-95. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4297315/. DOI: 10.1016/j.jacc.2014.10.031.

11. Günaydin B, Cakici I, Soncul H, et al. Does remote organ ischemia trigger cardiac preconditioning during coronary artery surgery? Pharmacol. Res 2000; 41 (4): 493-6.

12. Cho YJ, Lee EH, Lee K, et al. Long-term clinical outcomes of Remote Ischemic Preconditioning and Postconditioning Outcome (RISPO) trial in patients undergoing cardiac surgery. Int J Cardiol 2016; 231: 84-9. DOI: 10.1016/j.ijcard.2016.12.146.

13. Lomivorotov VV, Karas’kov AM. Prekondicionirovanie v kardiohirurgii. Novosibirsk: Geo, 2010. 127 p. (In Russ.) Ломиворотов В. В., Караськов А. М. Прекондиционирование в кардиохирургии. Новосибирск: Гео, 2010. 127с.

14. Lymina NP, Kotelnikova EV, Karpova E, et al. Controlled physical rehabilitation based on ischemic preconditioning phenomenon in patients with ischemic heart disease with diastolic dysfunction. European Journal of Heart Failure 2014; 16 (2): 1747.