Remote ischaemic preconditioning in isolated aortic valve and coronary artery bypass surgery: a randomized trial

Marco Moscarelli, Francesca Fiorentino, M-Saadeh Suleiman, Costanza Emanueli, Barnaby Reeves, Prakash Punjabi, Gianni Angelini

Research output: Contribution to journalArticle (Academic Journal)peer-review

4 Citations (Scopus)
81 Downloads (Pure)


Objective: This trial was designed and started recruiting at a time when the benefits of remote ischemic preconditioning during open-heart surgery were still controversial. We focused on a homogeneous patient’s population undergoing either isolated aortic valve replacement (AVR) or coronary artery bypass graft surgery (CABG) by investigating cardiac injury, metabolic stress and inflammatory response.

Methods: A two-centre randomised controlled trial recruited a total of 124 patients between February 2013 and April 2015. Of these 64 patients underwent CABG and 60 patients AVR. Patients were randomized to either sham or preconditioning. Remote ischemic preconditioning was applied following anesthesia and before sternotomy. Myocardial injury and inflammatory response were assessed by serially measuring cardiac troponin I, and IL-6, 8, 10 and TNF-α. Biopsies from left and right ventricles were harvested after ischemic reperfusion injury for nucleotides analysis.

Results: Application of remote ischemic preconditioning did not alter troponin I release, levels of inflammatory markers and cardiac energetics in both CABG or AVR groups.

Conclusions: Preconditioning did not confer any additional cardioprotection in terms of troponin I, inflammatory markers reduction, and left and right ventricle energy metabolites preservation in patients undergoing isolated coronary artery bypass grafting or aortic valve surgery.
Original languageEnglish
Article numberezy404
Pages (from-to)905-912
Number of pages8
JournalEuropean Journal of Cardio-Thoracic Surgery
Issue number5
Early online date12 Dec 2018
Publication statusPublished - 1 May 2019

Structured keywords

  • Bristol Heart Institute
  • BTC (Bristol Trials Centre)


  • Remote ischaemic preconditioning
  • Coronary artery bypass grafting
  • Aortic valve replacement
  • Cardiac Injury


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