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Remote ischaemic preconditioning reduces myocardial injury in patients undergoing cardiac surgery with cold-blood cardioplegia: a randomised controlled trial.
- Source :
-
Heart (British Cardiac Society) [Heart] 2009 Oct; Vol. 95 (19), pp. 1567-71. Date of Electronic Publication: 2009 Jun 08. - Publication Year :
- 2009
-
Abstract
- Background: Remote ischaemic preconditioning (RIPC) induced by brief ischaemia and reperfusion of the arm 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 world wide.<br />Objective: To assess whether RIPC is cardioprotective in CABG patients receiving cold-blood cardioplegia.<br />Design: Single-centre, single-blinded, randomised controlled trial.<br />Setting: Tertiary referral hospital in London.<br />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 past 4 weeks were excluded.<br />Interventions: Patients were randomised to receive either RIPC (n = 23) or control (n = 22) after anaesthesia. RIPC comprised three 5 min cycles of right forearm ischaemia, induced by inflating a blood pressure cuff on the upper arm to 200 mm Hg, with an intervening 5 min reperfusion. The control group had a deflated cuff placed on the upper arm for 30 min.<br />Main Outcome Measures: Serum troponin T was measured preoperatively and at 6, 12, 24, 48 and 72 h after surgery and the area under the curve (AUC at 72 h) calculated.<br />Results: RIPC reduced absolute serum troponin T release by 42.4% (mean (SD) AUC at 72 h: 31.53 (24.04) microg/l.72 h in controls vs 18.16 (6.67) microg/l.72 h in RIPC; 95% CI 2.4 to 24.3; p = 0.019).<br />Conclusions: Remote ischaemic preconditioning induced by brief ischaemia and reperfusion of the arm reduces myocardial injury in CABG surgery patients undergoing cold-blood cardioplegia, making this non-invasive cardioprotective technique widely applicable clinically.<br />Trial Registration Number: NCT00397163.
- Subjects :
- Adolescent
Adult
Aged
Biomarkers blood
Female
Humans
Male
Middle Aged
Myocardial Reperfusion Injury blood
Single-Blind Method
Treatment Outcome
Troponin T blood
Young Adult
Coronary Artery Bypass methods
Heart Arrest, Induced methods
Ischemic Preconditioning, Myocardial methods
Myocardial Reperfusion Injury prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1468-201X
- Volume :
- 95
- Issue :
- 19
- Database :
- MEDLINE
- Journal :
- Heart (British Cardiac Society)
- Publication Type :
- Academic Journal
- Accession number :
- 19508973
- Full Text :
- https://doi.org/10.1136/hrt.2008.155770