| Objective: The present study is aimed to investigate whether remote ischaemic preconditioning (RIPC), an intervention in which brief ischaemia of one tissue or organ protects remote organs from a sustained episode of ischaemia, is beneficial for patients undergoing valve replacement surgery. Another objective of the present study is to evaluate the value of ischemia modified albumin (IMA) as a biomarker to reflect the cardiac injury in patients undergoing valve replacement.Methods: 70 adult patients undergoing valvular replacement surgery were randomly assigned to either RIPC (n=35) or to a control group (n=35) after induction of anaesthesia. RIPC consisted of three 5-min cycles of right upper limb ischaemia, induced by a manual cuff-inflator placed on the upper arm and inflated to 200 mmHg, with an intervening 5 min of reperfusion during which the cuff was deflated. Serum troponin I, CK, CK-MB, tumor necrosis factor-alpha (TNF-α) and IMA concentration were measured before surgery and at 1, 3, 6 and 24 hr after cardiopulmonary bypass (CPB). Analysis was by intention to treat.Results: RIPC significantly reduced the overall serum troponin I and CK-MB levels after CPB. In addition, serum TNF-αlevel was also lower in patients with RIPC than the control patients. After surgery, the serum IMA level was dramatically increased at 1, 3 and 6 hr as compared with the basal level. At 24 hour, the serum IMA level returned to the basal level. However, there was not significant difference of IMA level between RIPC and control group (p=0.87).Conclusion: The present study demonstrates that adult patients undergoing valvular replacement surgery could benefit from RIPC, using transient upper limb ischemia. The present study also shows that IMA is a sensitive marker of cardiac ishemia/injury, however, it is not a specific marker to reflect the extent of cardiac injury in patients undergoing CPB.
|
PDF Full Text Request