Abstract
Background: Cardioprotective effect of remote ischemic preconditioning (RIPC) in cardiovascular surgery is controversy. This study investigated whether RIPC combined with remote ischemic postconditioning (RIPostC) reduces myocardial injury on donor hearts in patients undergoing heart transplantation.
Methods: One hundred and twenty patients scheduled for orthotopic heart transplantation were enrolled and randomly assigned to an RIPC+RIPostC group (n=60) or a control (n=60) group. In the RIPC+RIPostC group, four cycles of 5-min ischemia and 5-min reperfusion were applied on the right upper limb by a cuff inflated to 200mmHg after anesthesia induction (RIPC) and 20 minutes after aortic declamping (RIPostC). Serum cardiac troponin I (cTnI) level was determined preoperatively and at 3, 6, 12, 24 h after aortic declamping. Postoperative clinical outcomes were recorded. The primary endpoint was comparison of the cTnI levels at 6 h after aortic declamping.
Results: Compare with the preoperative baseline, serum cTnI levels peaked at 6h after aortic declamping in two groups. Compare with the control group, RIPC+RIPostC significantly reduced the serum cTnI levels at 6h after aortic declamping (38.87±31.81 vs 69.30±34.13ng/ml, P=0.018). There was no significant difference in in-hospital morbidity and mortality between the two groups.
Conclusion: In patients undergoing orthotopic heart transplantation, RIPC combined with RIPostC reduced myocardial injury at 6h after aortic declamping，while we found no evidence of this function provided by RIPC+RIPostC could improve clinical outcomes
Trial Registration: Trial Registration Number: chictr.org.cn. no. ChiCTR-INR-16010234. (Prospectively registered). The initial registration date was 9/1/2017.
Keywords: Ischemia; preconditioning; postconditioning; heart transplantation
Interventricular conduction disorders after orthotopic heart transplantation: risk factors and clinical relevance
