Remote perconditioning reduces myocardial injury in adult valve replacement: a randomized controlled trial.
BACKGROUND
Remote perconditioning has been proved to reduce myocardial infarction and improve ventricular function in vivo. This study aims to determine the protection of remote perconditioning against cardiac reperfusion injury in patients undergoing valve replacement.


METHODS
Eighty-one patients admitted for selective valve replacement were divided into three groups randomly. Control patients (con. n = 27) underwent sham placement of the tourniquet around the right thigh without inflation; the remote preconditioning group (pre. n = 26) received three cycles of 4/4 min right lower limb ischemia and reperfusion after induction of anesthesia, the limb ischemia was induced by the tourniquet inflated to 600 mmHg; the remote perconditioning group (per. n = 28) received the same stimulus immediately after aortic cross-clamping. Venous blood samples were obtained preoperatively, 5 min before declamping, 30 min, 4, 12, and 72 h after declamping for detecting troponin I (cTnI) concentration. The clinical data of inotrope requirement, drainage, ventilation. and intensive care time were routinely recorded.


RESULTS
The remote perconditioning group had significantly lower release of cTnI 5 min before declamping (con. versus pre. versus per., 0.15 ± 0.10 versus 0.13 ± 0.08 versus 0.10 ± 0.04 ng/mL, P = 0.050) and 30 min after declamping (con. versus pre. versus per., 0.40 ± 0.24 versus 0.41 ± 0.40 versus 0.24 ± 0.13 ng/mL, P = 0.043). Less incidence of defibrillation were observed in the remote perconditioning groups.


CONCLUSIONS
Remote perconditioning, which is induced by transient lower limb ischemia after aortic cross-clamping, reduces myocardial injury over cardioplegia in adults undergoing selective valve replacement.
Li
Li
L
Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China.
Luo
Wanjun
W
Huang
Lingjin
L
Zhang
Weixing
W
Gao
Yang
Y
Jiang
Haihe
H
Zhang
Chunfang
C
Long
Long
L
Chen
Shengxi
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery; D005260:Female; D006324:Heart Arrest, Induced; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D013525:Surgical Instruments; D014111:Tourniquets; D019210:Troponin I / Q000097:blood
D019210:Troponin I