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Remote Ischaemic preconditioning reduces myocardial injury in patients undergoing cardiac surgery with cold blood cardioplegia:a randomised controlled trial
  1. Vinod Venugopal (v.venugopal{at}ucl.ac.uk)
  1. The Hatter Cardiovascular Institute, University College London Hospital & Medical School, United Kingdom
    1. Derek J Hausenloy (d.hausenloy{at}ucl.ac.uk)
    1. The Hatter Cardiovascular Institute, University College London Hospital & Medical School, United Kingdom
      1. Andrew Ludman (a.ludman{at}ucl.ac.uk)
      1. The Hatter Cardiovascular Institute, University College London Hospital & Medical School, United Kingdom
        1. Carmelo Di Salvo, Mr (carmelodisalvo{at}uclh.org)
        1. The Heart Hospital, UCLH, United Kingdom
          1. Shyam Kolvekar (shyam.kolvekar{at}uclh.org)
          1. The Heart Hospital, UCLH, United Kingdom
            1. John Yap (john.yap{at}uclh.org)
            1. The Heart Hospital, UCLH, United Kingdom
              1. David Lawrence (david.lawrence{at}uclh.org)
              1. The Heart Hospital, UCLH, United Kingdom
                1. Guilio Bognolo (john.bognolo{at}uclh.org)
                1. The Heart Hospital, UCLH, United Kingdom
                  1. Derek M Yellon (d.yellon{at}ucl.ac.uk)
                  1. The Hatter Cardiovascular Institute, University College London Hospital & Medical School, United Kingdom

                    Abstract

                    Objective: Remote ischaemic preconditioning (RIPC) induced by brief limb ischaemia reduces myocardial injury in coronary artery bypass (CABG) surgery patients receiving predominantly cross-clamp fibrillation for myocardial protection. However, cold-blood cardioplegia is the more commonly used method worldwide. This study was designed to assess whether RIPC is cardioprotective in CABG patients receiving cold-blood cardioplegia.

                    Design: Single centre, single-blinded, randomised controlled trial.

                    Setting: Tertiary referral hospital in London.

                    Patients: Adults patients (18-80 years) undergoing elective CABG surgery with or without concomitant aortic valve surgery with cold-blood cardioplegia. Patients with diabetes, renal failure (serum creatinine >130 mmol/L), hepatic or pulmonary disease, unstable angina or myocardial infarction within the last 4 weeks were excluded.

                    Interventions: Patients were randomised to receive either RIPC (n=23) or control (n=22) following anaesthesia. RIPC comprised three 5-min cycles of right forearm ischaemia, induced by inflating a blood pressure cuff on the upper arm to 200mmHg, with an intervening 5 min reperfusion. The control group had a deflated cuff placed on the upper arm for 30min.

                    Main outcome measures: Serum troponin-T was measured pre-operatively and at 6, 12, 24, 48 and 72 hours post-surgery and the area under the curve (AUC72hrs) calculated.

                    Results: RIPC reduced absolute serum troponin-T release by 42.4% (AUC72hours 31.53±24.04 μg/L.72hrs in RIPC vs 18.16±6.67μg/L.72hrs in control; 95% CI 2.4–24.3; p=0.019).

                    Conclusions: Remote ischaemic preconditioning induced by brief ischaemia of the arm reduces myocardial injury in CABG patients receiving cold-blood cardioplegia making this non-invasive cardioprotective technique widely applicable clinically.

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