Intermittent hypoxic preconditioning reduces the risk of peri- and postoperative complications during on-pump cardiac surgery

Aim. To assess the effect of intermittent hypoxic-hyperoxic exposures (IHHE) on the outcomes of on-pump cardiac surgery.Material and methods. This prospective, single-center, randomized, controlled study was conducted in 110 patients with heart valve defects and/or aortic pathology from the cardiac surgery clinic of the I. M. Sechenov First Moscow State Medical University. The total sample was randomly divided into a group of patients who underwent IHHE (n=66) and a control group of patients who underwent placebo procedures with ambient air (n=44). The frequency and structure of intra-and postoperative complications were analyzed within 30 days after surgery. The presence of cognitive impairment, as well as serum troponin I and lactate concentrations were analyzed before and after surgery.Results. Peri- and early postoperative complications such as cardiac death, non-fatal infarction and acute heart failure occurred significantly less frequently in patients treated with IHHE compared with placebo group (1,6% vs 16,7%, p=0,009; 1,6% vs 16,7%, p=0,009; 6,3% vs 33,3%, p<0,001, respectively). The median troponin I values 24 hours after surgery were 1,068 ng/ml (0,388-1,397 ng/ml) in the IHHE group and were significantly lower compared to the control group (1,980 ng/ml (1,068-3,239 ng/ml)). The serum lactate level after surgery was 1,8±0,7 mmol/l in the IHHE group and was significantly lower compared to the control group — 2,4±1,2 (p=0,05). Cognitive function, assessed by MOCA and MMSE tests, turned out to be significantly higher in patients who underwent a preoperative IHHE. No significant complications or serious adverse events were observed during the IHHE procedures.Conclusion. The use of individually adapted hypoxic preconditioning procedures reduces the incidence of peri- and postoperative complications, which is accompanied by a lower ischemia-reperfusion myocardial injury during artificial circulation with preservation of cognitive functions. IHHE procedures ramp up prehabilitation of patients referred for on-pump surgery of heart defects and aortic pathology

Evaluation of the effects of interval hypoxic-hyperoxic training in patients with metabolic syndrome

Abstract Introduction Metabolic syndrome (MS) as a “cluster” of interrelated disorders, including insulin resistance, visceral obesity, dyslipidemia, and hypertension, is an serious clinical problem that is a high risk factor for the development of type 2 diabetes, acceleration of the development and progression of cardiovascular diseases, and such increasingly common liver damage like non-alcoholic fatty liver disease. According to a number of authors, metabolic syndrome is a reversible condition, and with early diagnosis and treatment, a reduction in the severity of manifestations of this syndrome can be achieved. A significant role in the treatment of MS and obesity is played by non-drug methods – dosed physical activity, diet, various physiotherapeutic procedures, as well as interval hypoxic-hyperoxic training (IHHT). Objective Evaluation of the effect of interval hypoxic-hyperoxic training (IHHT) on the components of metabolic syndrome, and the possibility of their reversal recovery. Materials and methods The study included 65 patients (33 men) with metabolic syndrome, aged 29–66 years. The patients were divided into 2 groups: study and control (the groups were matched by sex, age, presence of MS components and number of comorbidities). Initially, anthropometric, laboratory and instrumental studies were carried out. The patients of the main group underwent a course of IHHT for 3 weeks, 5 days a week (15 workouts). Patients in the control group underwent a course of training simulating IHHT (placebo), which also consisted of 15 trainings. The duration of one procedure was 40 minutes. Next day after the end of the training course, the changes in all initial parameters were assessed. Results The statistical significance of changes after the IGGT course was assessed using the Wilcoxon test as p&amp;lt;0.05 and was detected in the main group according to the following parameters: reduction in arterial stiffness, measured using CAVI (Cardio-Ankle Vascular Index, on the Fukuda Denshi ap.), a decrease in the stage of liver fibrosis and stiffness of liver tissue (was realized by a non-invasive method, a liver elastometry, on the FibroScan ap. Echosense), a decrease in high-sensitivity C-reactive protein, heat shot protein-70, a decrease in total cholesterol, low density lipoproteins, triglycerides levels. According to nitric oxide, transforming growth factor beta-1, heart-type fatty acid binding protein, there was no significant dynamics after the IHHT course in both groups. There was also a tendency towards a decrease in the indices of the abdominal/hip circumference, weight, and in blood pressure, but this results was not statistically significant, due to the insufficient power of the study (a small number of patients). Conclusions IHHT is a safe, well-tolerated procedure and is recommended in the therapeutic and prophylactic plan for patients with metabolic syndrome, and is effective in correcting and minimizing the components of this syndrome. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): This work was financed by the Ministry of Science and Higher Education of the Russian Federation within the framework of state support for the creation and development of World-Class Research Centers “Digital biodesign and personalized healthcare” </jats:sec