Remote ischaemic preconditioning reduces myocardial injury in patients undergoing heart valve surgery: randomised controlled trial
- Jian-Jiang Xie1,
- Xiao-Long Liao2,
- Wen-Guang Chen1,
- Da-De Huang1,
- Feng-Jun Chang2,
- Wen Chen3,
- Zhao-Liu Luo1,
- Zhi-Ping Wang2,
- Jing-Song Ou2
- 1Surgery/Cardiothoracic, Guangzhou First Municipal People's Hospital, Guangzhou Institute of Clinical Medicine, Guangzhou Medical College, Guangzhou, P.R. China
- 2Division of Cardiac Surgery, The Key Laboratory of Assisted Circulation, Ministry of Health, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China
- 3Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, P.R. China
- Correspondence to Dr Jing-song Ou, Division of Cardiac Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhong Shan Er Road, Guangzhou 510080, P.R. China;
Contributors JSO was the principal investigator and designed the trial. JJX, WGC and XLL recruited patients and administered the treatment protocol. JJX, WGC and FJC collected blood samples. JJX, XLL and FJC followed up the patients. JSO, JJX, XLL and WC analysed the data. JSO, WGC, DDH, ZPW and ZLL were the cardiac surgeons. JJX prepared the manuscript. JSO and ZPW revised the manuscript.
- Accepted 21 October 2011
- Published Online First 22 November 2011
Objective To determine whether remote ischaemic preconditioning (RIPC) is cardioprotective in patients undergoing heart valve replacement.
Design Single-blinded, randomised controlled trial.
Setting Tertiary referral hospital in China.
Patients Adult patients (31–72 years) undergoing mitral valve, aortic valve or tricuspid valve surgery.
Interventions 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.
Main 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.
Results 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.
Conclusions These data indicate that RIPC reduces myocardial injury and improves cardiac function in patients undergoing heart valve surgery.
Trial registration number NCT01175681.
- ischaemic preconditioning
- myocardial injury
- cardiac function
- nitric oxide
- cardiac surgery
- endothelial function
JJX and XLL contributed equally to this study.
Funding This study was supported by a start-up fund by the Guangzhou First Municipal People's Hospital, a start-up fund by the Sun Yat-sen University, and the Fundamental Research Funds for the Central Universities, the Ministry of Education of China.
Competing interests None.
Patient consent Obtained.
Ethics approval Guangzhou First Municipal People's Hospital Ethics Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.