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Effect of remote ischemic preconditioning on renal dysfunction after complex valvular heart surgery: a randomized
Yong Seon Choi1, Jae Kwang Shim, Jong Chan Kim
1Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
The Journal of Thoracic and Cardiovascular Surgery
|January 29, 2011
Summary
Remote ischemic preconditioning did not prevent acute kidney injury in complex valvular heart surgery patients. However, it did reduce myocardial injury and intensive care unit stay, suggesting potential benefits beyond renal protection.
Area of Science:
- Cardiology
- Nephrology
- Surgical Critical Care
Background:
- Acute kidney injury (AKI) is a significant complication following cardiac surgery with cardiopulmonary bypass, linked to systemic inflammation and oxidative stress.
- Remote ischemic preconditioning (RIPC) is a technique involving brief limb ischemia to induce systemic protection against distant organ injury.
- The efficacy of RIPC in protecting kidneys from AKI during complex valvular heart surgery remains to be fully elucidated.
Purpose of the Study:
- To investigate the systemic protective effect of RIPC on renal function in patients undergoing complex valvular heart surgery.
- To evaluate whether RIPC reduces the incidence and severity of AKI in this patient population.
- To assess secondary outcomes including myocardial injury and intensive care unit (ICU) stay.
Main Methods:
- A randomized controlled trial involving 76 adult patients undergoing complex valvular heart surgery.
- Patients were assigned to either RIPC (3 cycles of 10-minute lower limb ischemia/reperfusion) or a control group.
- Primary endpoints included serum creatinine, cystatin C, neutrophil gelatinase-associated lipocalin, and AKI incidence. Secondary endpoints were myocardial enzyme release and pulmonary parameters.
Main Results:
- No significant differences in renal injury biomarkers or AKI incidence were observed between the RIPC and control groups.
- Creatine kinase-MB levels at 24 hours post-surgery were lower in the RIPC group.
- Intensive care unit (ICU) stay was shorter for patients in the RIPC group compared to the control group.
Conclusions:
- Remote ischemic preconditioning did not demonstrate a protective effect against renal injury or AKI in patients undergoing complex valvular heart surgery.
- RIPC was associated with reduced myocardial injury and a shorter ICU stay in this cohort.
- Further research may be needed to explore the specific mechanisms and patient selection for RIPC in cardiac surgery.
