Remote Ischemic Preconditioning in Patients Undergoing Isolated Aortic Valve Replacement Surgery

Remote Ischemic Preconditioning in Patients Undergoing Isolated Aortic Valve Replacement Surgery With a Biological Prosthesis: A Single Center Randomized Prospective Study

The goal is to investigate the efficacy, safety and possible neuro- and cardioprotective effects of remote ischemic preconditioning (RIPC) in adult cardiac patients undergoing isolated aortic valve replacement surgery with a biological prosthesis. Neuropsychological evaluation preoperatively and at 30d after surgery will establish if there are any differences in neuropsychological performance between groups. A large array of biochemical markers will be analyzed from plasma samples taken at different time points. Additionally skin biopsies from the lower limb will be taken before and after performing RIPC on said limb. During the venous cannulation phase a atrial biopsy will be taken. The biochemical markers from plasma and tissue samples will be used to asses brain tissue damage, inflammation and cardiac tissue damage between groups.

This will be a single center prospective randomized study with two groups. A intervention group (RIPC) and a control group. Study size is: 40 patients in total, 20 patients per group.

Inclusion Criteria:

• Non-emergency aortic valve replacement with a biological prosthesis with perfusion and cardiac arrest

Exclusion Criteria:

• Recent myocardial infarction
• Carotid stenosis requiring intervention
• Any other concomitant surgical procedure
• Increased troponin baseline before surgery
• Critical ischemia of lower limbs
• Peripheral arterial disease (ASO, media sclerosis)
• Morbid obesity (Incompatible cuff-to-thigh diameter)
• Severe heart insufficiency
• Moderate to severe venous insufficiency lower limbs
• Recent acute stroke <90d
• Difference in cardioplegic protocol
• Diseased aorta in epiaortic ultrasound