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Remote ischaemic preconditioning in isolated aortic valve and coronary artery bypass surgery: a randomized trial†

Marco Moscarelli1, Francesca Fiorentino2, M-Saadeh Suleiman1

  • 1Faculty of Health Sciences, Bristol Heart Institute, The Bristol Medical School, University of Bristol, Bristol, UK.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|December 14, 2018
PubMed

Insights

Remote ischaemic preconditioning did not improve outcomes in patients undergoing cardiac surgery. This study found no significant reduction in cardiac injury or inflammatory markers with preconditioning in coronary artery bypass grafting or aortic valve replacement patients.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Critical Care Medicine

Background:

  • The efficacy of remote ischaemic preconditioning (RIPC) during cardiac surgery was investigated during a period of ongoing debate regarding its benefits.
  • The study focused on a specific patient cohort undergoing isolated aortic valve replacement (AVR) or coronary artery bypass grafting (CABG).

Purpose of the Study:

  • To evaluate the impact of RIPC on cardiac injury, metabolic stress, and inflammatory response in patients undergoing isolated CABG or AVR.
  • To determine if RIPC offers additional cardioprotection in this patient population.

Main Methods:

  • A 2-centre randomized controlled trial involving 124 patients (64 CABG, 60 AVR) between February 2013 and April 2015.
  • Patients were randomized to receive either sham procedure or RIPC prior to sternotomy.
  • Cardiac injury (troponin I), inflammatory markers (IL-6, IL-8, IL-10, TNF-α), and myocardial nucleotide levels were assessed.

Main Results:

  • RIPC did not significantly alter troponin I release, a marker of cardiac injury, in either the CABG or AVR groups.
  • Levels of key inflammatory markers remained unchanged following RIPC application.
  • Analysis of myocardial biopsies showed no significant difference in energy metabolites between the RIPC and sham groups.

Conclusions:

  • RIPC did not provide additional cardioprotection for patients undergoing isolated CABG or aortic valve surgery.
  • The intervention failed to reduce cardiac injury markers or inflammatory responses.
  • No preservation of left and right ventricle energy metabolites was observed with RIPC.
Abstract

Keywords:
Aortic valve replacementCardiac injuryCoronary artery bypass graftingRemote ischaemic preconditioning

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