Author(s): Young PJ, Dalley P, Garden A, Horrocks C, La Flamme A,
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Abstract The efficacy of remote ischemic preconditioning (RIPC) in high-risk cardiac surgery is uncertain. In this study, 96 adults undergoing high-risk cardiac surgery were randomised to RIPC (3 cycles of 5 min of upper-limb ischemia induced by inflating a blood pressure cuff to 200 mmHg with 5 min of reperfusion) or control. Main endpoints were plasma high-sensitivity troponin T (hsTNT) levels at 6 and 12 h, worst post-operative acute kidney injury (AKI) based on RIFLE criteria, and noradrenaline duration. hsTNT levels were log-normally distributed and higher with RIPC than control at 6-h post cross-clamp removal [810 ng/ml (IQR 527-1,724) vs. 634 ng/ml (429-1,012); ratio of means 1.41 (99.17\% CI 0.92-2.17); P=0.04] and 12 h [742 ng/ml (IQR 427-1,700) vs. 514 ng/ml (IQR 356-833); ratio of means 1.56 (99.17\% CI 0.97-2.53); P=0.01]. After adjustment for baseline confounders, the ratio of means of hsTNT at 6 h was 1.23 (99.17\% CI 0.88-1.72; P=0.10) and at 12 h was 1.30 (99.17\% CI 0.92-1.84; P=0.05). In the RIPC group, 35/48 (72.9\%) had no AKI, 5/48 (10.4\%) had AKI risk, and 8/48 (16.7\%) had either renal injury or failure compared to the control group where 34/48 (70.8\%) had no AKI, 7/48 (14.6\%) had AKI risk, and 7/48 (14.6\%) had renal injury or failure (Chi-squared 0.41; two degrees of freedom; P = 0.82). RIPC increased post-operative duration of noradrenaline support [21 h (IQR 7-45) vs. 9 h (IQR 3-19); ratio of means 1.70 (99.17\% CI 0.86-3.34); P=0.04]. RIPC does not reduce hsTNT, AKI, or ICU-support requirements in high-risk cardiac surgery.
This article was published in Basic Res Cardiol
and referenced in Journal of Clinical & Experimental Cardiology