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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