Remote ischemic preconditioning for myocardial protection during single valvular heart surgery: a randomized-controlled trial

Objectives
This study aimed to investigate the potential of remote ischemic preconditioning (RIPC) in myocardial protection after elective single valve replacement.
Patients and methods
Forty patients were randomized to single valve replacement (mitral or aortic) with RIPC or conventional single valve replacement (control). The RIPC protocol was induced by four (5 min) cycles of upper limb ischemia and (5 min) reperfusion using a blood-pressure cuff. Troponin I level at 30 min preoperatively, 3, 6, 12, and 24 h postoperatively, operative time, the duration of cardioplegia, aortic cross-clamping time, cardiopulmonary bypass time, the length of ICU stay, ventilation time, dose of inotropic support requirements, and hemodynamic parameters (central venous pressure, urine output, and mean arterial pressure) were recorded.
Results
The RIPC group showed a highly significant decrease in serum troponin level at 6, 12, and 24 h postoperatively. There were no significant differences between groups in operative time, duration of cardioplegia, cross-clamping duration, cardiopulmonary bypass time, and hemodynamic parameters. The length of ICU stay and ventilation time showed a nonsignificant decrease in the RIPC group. Total inotropic support in the first 24 h postoperatively showed a highly significant reduction in the RIPC group.
Conclusion
RIPC reduced the total amount of troponin I significantly postoperatively; also, it decreased the inotropic support needed postoperatively and nonsignificantly improved the ventilation time and ICU stay time.