Cardioprotective effect of remote ischemic preconditioning with postconditioning on donor hearts in patients undergoing heart transplantation: a single-center, double-blind, randomized controlled trial

Abstract

Background The cardioprotective effect of remote ischemic preconditioning (RIPC) in cardiovascular surgery is controversial. This study investigated whether RIPC combined with remote ischemic postconditioning (RIPostC) reduces myocardial injury to 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, after anesthesia induction, four cycles of 5-min of ischemia and 5-min of reperfusion were applied to the right upper limb by a cuff inflated to 200 mmHg (RIPC) and 20 min after aortic declamping (RIPostC). Serum cardiac troponin I (cTnI) levels were determined preoperatively and at 3, 6, 12, and 24 h after aortic declamping. Postoperative clinical outcomes were recorded. The primary endpoint was a comparison of serum cTnI levels at 6 h after aortic declamping. Results Compared with the preoperative baseline, in both groups, serum cTnI levels peaked at 6 h after aortic declamping. Compared with the control group, RIPC+RIPostC significantly reduced serum cTnI levels at 6 h after aortic declamping (38.87 ± 31.81 vs 69.30 ± 34.13 ng/ml, P = 0.02). There were no significant differences 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 6 h 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.

A Case of Heart Transplantation after Ischaemic Preconditioning

“…Longer recovery times were noted for those hearts that experienced a preconditioning stimulus longer than 30 minutes, suggesting that ischaemic times longer than this are harmful rather than cardio-protective. A subsequent double-blind randomized controlled trial on the cardioprotective effect of remote IPC on donor hearts in patients undergoing heart transplantation was published in April, 2019 with favourable results [8].…”

“…The authors cannot in any way be certain of the reasons for the favorable outcome of this heart transplantation following [8] Donor hearts are increasingly being harvested following circulatory deaths in an effort to broaden the donor pool. More focused studies on the effects of ischaemic preconditioning in the course of cardiac transplantations such as the one described here may shed more light on the clinical significance of this phenomenon.…”

Anesthesia Management at Fuwai Hospital: Practice, Evidence and Outcomes<span style="font-size:12px;"><span style="font-size:9px;"></span></span>

“…Numerous evidence has indicated that, volatile anesthetic agents (isoflurane, sevoflurane and desflurane) have the potential to provide organ(e.g., heart, kidney, brain) protection via pre-and post-conditioning-like mechanisms. 28 Most CPB machines at Fuwai Hospital are equipped with sevoflurane vaporizers, enabling sevoflurane administration during CPB for anesthesia maintenance and the employment of sevoflurane preconditioning (SPreC) and sevoflurane post-conditioning 34 One hundred and twenty patients scheduled for heart transplantation were enrolled and randomly assigned into RIPC+RIPostC group (n=60) or control group (n=60). The findings indicated that, RIPC+RIPostC significantly reduced serum cTnI levels at 6 h after aortic declamping, but there was no significant difference with respect to in-hospital morbidity and mortality between the two groups.…”

“…The findings indicated that, RIPC+RIPostC significantly reduced serum cTnI levels at 6 h after aortic declamping, but there was no significant difference with respect to in-hospital morbidity and mortality between the two groups. 34 Chinese Medical Sciences Journal…”

Randomised sham-controlled double-blind trial evaluating remote ischaemic preconditioning in solid organ transplantation: a study protocol for the RIPTRANS trial

“…An RIPC intervention done to heart transplant recipients together with post conditioning 20 min after aortic declamping reduced cTnI levels at 6 hours after transplantation. 18 In a recent trial RIPC done to living liver donors reduced postoperative aspartate aminotransferase levels in liver recipients, 19 whereas a pilot study of the RIPCOLT trial with RIPC done on liver transplant recipients demonstrated no short-term benefits. 20 Direct ischaemic preconditioning with clamping of liver hilum in DBD was not was not beneficial and could even induce excessive ischaemic damage.…”