Remote Ischemic Preconditioning in Coronary Artery Bypass Grafting With Cold Crystalloid Cardioplegic Arrest

Effect of Remote Ischemic Preconditioning in Patients Undergoing On-pump Coronary Artery Bypass Graft Surgery With Crystalloid Cardioplegic Arrest

Remote ischemic preconditioning (RIPC) with transient upper limb ischemia/reperfusion reduces myocardial injury in patients undergoing on-pump coronary artery bypass (CABG) surgery with cross-clamp fibrillation or blood cardioplegia for myocardial protection. The present study assesses protection of heart, brain and kidney by RIPC under crystalloid cardioplegic arrest. The study also addresses safety and clinical outcome.

Remote ischemic preconditioning (RIPC) protocol after induction of anesthesia and before skin incision consists of 3 cycles of 5 minutes left upper arm ischemia by inflation of a blood pressure cuff to 200 mmHg and 5 minutes of reperfusion. For myocardial molecular analyses, left ventricular biopsies are taken before induction of cardioplegic cardiac arrest and at 10 minutes after aortic unclamping during reperfusion of the myocardium.

Inclusion Criteria:

• Consecutive patients >18 years of age
• Double- or triple-vessel coronary artery disease
• Elective isolated first-time CABG
• Combined valve surgery + CABG
• Written informed consent

Exclusion Criteria:

• Renal failure (creatinine ≥ 200 µmol/L)
• Peripheral vascular disease affecting upper limbs
• Preoperative inotropic support
• Any kind of mechanical assist device
• Acute or recent (<4 weeks) acute coronary syndromes
• Any PCI (<6 weeks)
• Any reasons for preoperative cTnI elevation
• Emergency surgery
• Redo surgery