Remote ischemic preconditioning in aortic valve surgery: Results of a randomized controlled study.
BACKGROUND
Although remote ischemic preconditioning (RIPC) has emerged as an attractive strategy to reduce cardiac injury in patients undergoing diverse cardiac surgical procedures, it is unclear whether RIPC has protective effects in patients undergoing aortic valve replacement surgery without coronary artery bypass grafting (CABG).


METHODS
Hence, 100 adult patients undergoing elective aortic valve replacement for aortic valve stenosis, without combined surgery with CABG, were prospectively randomly assigned in a 1:1 ratio to either the RIPC group or the control group. The RIPC group underwent three cycles of 5-min inflation to 200mmHg and 5-min deflation of an automated upper-arm cuff inflator after induction of anesthesia. The control group had a deflated cuff placed on upper arm for 30min. The primary endpoint was 72-h area under curve (AUC) for troponin I (cTnI). Secondary endpoints were 72-h AUC for creatine kinase-MB isoenzyme (CK-MB) release, incidence of acute kidney injury, extubation time, length of stay in intensive care unit, and simplified acute physiology score (SAPS II).


RESULTS
There were no significant differences in cTnI AUC [195±190 arbitrary units (a.u.) in RIPC group vs. 169±117 a.u. in the control group; p=0.41] and CK-MB AUC between groups. None of the other secondary endpoints differed between groups. Acute kidney injury occurred in 12 patients (24.5%) in the control group and in 13 (26.0%) in the RIPC group (p=0.86).


CONCLUSIONS
RIPC did not exhibit significant cardiac or kidney protective effects in patients undergoing aortic valve replacement surgery without CABG.
L'UNAM Université, France; CHU Angers, Service de Chirurgie Cardiaque, Angers, France; Université d'Angers, INSERM 1083, CNRS UMR 6214, Angers, France.
Frédéric
F
Pinaud
L'UNAM Université, France; CHU Angers, Service de Chirurgie Cardiaque, Angers, France.
Jean-Jacques
JJ
Corbeau
L'UNAM Université, France; CHU Angers, Service de Chirurgie Cardiaque, Angers, France; Université d'Angers, EA 3860 Cardioprotection, Remodelage et Thrombose, Angers, France.
Christophe
C
Baufreton
L'UNAM Université, France; CHU Angers, Service de Chirurgie Cardiaque, Angers, France; Université d'Angers, EA 3860 Cardioprotection, Remodelage et Thrombose, Angers, France.
Jean-Patrice
JP
Binuani
L'UNAM Université, France; CHU Angers, Service de Chirurgie Cardiaque, Angers, France; Université d'Angers, EA 3860 Cardioprotection, Remodelage et Thrombose, Angers, France.
Jean-Louis
JL
De Brux
L'UNAM Université, France; CHU Angers, Service de Chirurgie Cardiaque, Angers, France; Université d'Angers, INSERM 1083, CNRS UMR 6214, Angers, France.
Olivier
O
Fouquet
Université François Rabelais de Tours, EA 4245 Cellules Dendritiques Immunomodulation et Greffes, CHRU de Tours, Service de Cardiologie, Tours, France.
Denis
D
Angoulvant
L'UNAM Université, France; Université d'Angers, EA 3860 Cardioprotection, Remodelage et Thrombose, Angers, France; CHU Angers, Service de Cardiologie, Angers, France.
Alain
A
Furber
L'UNAM Université, France; Université d'Angers, EA 3860 Cardioprotection, Remodelage et Thrombose, Angers, France; CHU Angers, Service de Cardiologie, Angers, France. Electronic address: faprunier@chu-angers.fr.
Fabrice
F
Prunier
D058186:Acute Kidney Injury / Q000453:epidemiology; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D016037:Single-Blind Method; D019210:Troponin I / Q000097:blood
D019210:Troponin I; D052279:Creatine Kinase, MB Form
Aortic valve replacement; Clinical trials (Registration: NCT01390129); Ischemia/reperfusion injury (heart); Myocardial protection/cardioplegia; Preconditioning (heart)