Remote ischaemic preconditioning reduces myocardial injury in patients undergoing heart valve surgery: randomised controlled trial.

by Jian-Jiang Xie, Xiao-Long Liao, Wen-Guang Chen, Da-De Huang, Feng-Jun Chang, Wen Chen, Zhao-Liu Luo, Zhi-Ping Wang, Jing-Song Ou show all authors
Heart (British Cardiac Society) ()


OBJECTIVE: To determine whether remote ischaemic preconditioning (RIPC) is cardioprotective in patients undergoing heart valve replacement.\n\nDESIGN: Single-blinded, randomised controlled trial.\n\nSETTING: Tertiary referral hospital in China.\n\nPATIENTS: Adult patients (31-72 years) undergoing mitral valve, aortic valve or tricuspid valve surgery.\n\nINTERVENTIONS: Patients were randomised to either the RIPC (n=38) or control (n=35) group. After induction of anaesthesia, patients in the RIPC group underwent three 5 min cycles of right upper limb ischaemia, induced by an automated cuff-inflator placed on the upper arm and inflated to 200 mm Hg. Each cycle was interrupted by a 5 min period of reperfusion during which time the cuff was deflated. The control group had only a deflated cuff placed on the upper arm for 30 min.\n\nMAIN OUTCOME MEASURES: Serum troponin I concentration was measured before surgery and at 6, 12, 24, 48, and 72 h postoperatively. The cardiac function of all patients was followed postoperatively.\n\nRESULTS: Troponin I concentration was reduced in the RIPC group (398.7±179.3 μg/l) compared with the control group (708.4±242.5 μg/l). Mean difference was 309.7±50.8 (95% CI 210.1 to 409.3, p<0.0001). A greater improvement in postsurgical cardiac function was noted in the RIPC group than in the control group.\n\nCONCLUSIONS: These data indicate that RIPC reduces myocardial injury and improves cardiac function in patients undergoing heart valve surgery.\n\nTRIAL REGISTRATION NUMBER: NCT01175681.

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