title: Multiorgan protection of remote ischemic perconditioning in valve replacement surgery.
abstract: BACKGROUND
  Remote ischemic perconditioning (RIPerc) is a new alternative of remote ischemic conditioning and has not been well studied. RIPerc attenuates myocardial injury when applied during cardiac surgery. However, its protective effects on other organs remain unknown.
  
  
  METHODS
  Patients with rheumatic heart disease undergoing valve replacement surgery were randomized into the RIPerc group (n = 101) or the control group (n = 100). RIPerc was achieved by three cycles of 5-min ischemia-5-min reperfusion in the right thigh during surgery. Clinical data and the levels of injury biomarkers for the heart, lungs, liver, and kidneys within 48 h after surgery were compared using one-way or repeated measurement analysis of variance.
  
  
  RESULTS
  In the RIPerc group, the release of serum cardiac troponin I (128.68 ± 102.56 versus 172.33 ± 184.38, P = 0.04) and the inotropic score (96.4 ± 73.8 versus 121.5 ± 89.6, P = 0.032) decreased compared with that of the control; postoperative drainage (458.2 ± 264.2 versus 545.1 ± 349.0 ml, P = 0.048) and the incidence of acute lung injury was reduced (36.6% versus 51%, P = 0.04), and the extent of hyperbilirubinemia was also attenuated. No significant difference was observed in the levels of biomarkers for renal injury and systemic inflammation response.
  
  
  CONCLUSIONS
  RIPerc applied during the valve replacement surgery induced multiple beneficial effects postoperatively including reduced drainage and myocardial damage, lower incidence of acute lung injury, and attenuated hyperbilirubinemia.
authors.affiliation: Department of Cardiothoracic Surgery, Xiangya Hospital, Central-South University, Changsha, Hunan, China.
authors.forename: Qinghua
authors.initials: Q
authors.lastname: Hu
authors.affiliation: Department of Cardiothoracic Surgery, Xiangya Hospital, Central-South University, Changsha, Hunan, China. Electronic address: luo3478@aliyun.com.
authors.forename: Wanjun
authors.initials: W
authors.lastname: Luo
authors.affiliation: Department of Cardiothoracic Surgery, Xiangya Hospital, Central-South University, Changsha, Hunan, China.
authors.forename: Lingjin
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of Cardiothoracic Surgery, Xiangya Hospital, Central-South University, Changsha, Hunan, China.
authors.forename: Rimao
authors.initials: R
authors.lastname: Huang
authors.affiliation: Department of Cardiothoracic Surgery, Xiangya Hospital, Central-South University, Changsha, Hunan, China.
authors.forename: Ri
authors.initials: R
authors.lastname: Chen
authors.affiliation: Department of Cardiothoracic Surgery, Xiangya Hospital, Central-South University, Changsha, Hunan, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Gao
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control; D055371:Acute Lung Injury / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D003331:Coronary Vessels / Q000502:physiology; D004311:Double-Blind Method; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D007668:Kidney / Q000098:blood supply / Q000378:metabolism; D008099:Liver / Q000098:blood supply / Q000378:metabolism; D008168:Lung / Q000098:blood supply / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000517:prevention & control*; D012214:Rheumatic Heart Disease / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: Acute kidney injury; Acute lung injury; Cardiac surgery; Remote ischemic perconditioning; Valvular heart disease