Faculty of Health Sciences, Bristol Heart Institute, The Bristol Medical School, University of Bristol, Bristol, UK.
Imperial College, National Heart and Lung Institute, London, UK.
Eur J Cardiothorac Surg. 2019 May 1;55(5):905-912. doi: 10.1093/ejcts/ezy404.
This trial was designed and patients were recruited at a time when the benefits of remote ischaemic preconditioning during open-heart surgery were still controversial. We focused on a homogeneous patient population undergoing either isolated aortic valve replacement or coronary artery bypass grafting (CABG) surgery by investigating cardiac injury, metabolic stress and inflammatory response.
A 2-centre randomized controlled trial recruited a total of 124 patients between February 2013 and April 2015. Of them, 64 patients underwent CABG and 60 patients underwent aortic valve replacement. Patients were randomized to either sham or preconditioning. Remote ischaemic preconditioning was applied following anaesthesia and before sternotomy. Myocardial injury and inflammatory response were assessed by serially measuring cardiac troponin I, and interleukin-6, 8, 10 and the tumour necrosis factor (TNF-α). Biopsies from the left and the right ventricles were harvested after ischaemic reperfusion injury for nucleotides analysis.
Application of remote ischaemic preconditioning did not alter the degree of troponin I release, levels of inflammatory markers and cardiac energetics in both the CABG and the aortic valve replacement groups.
Preconditioning did not confer any additional cardioprotection in terms of reducing the levels of troponin I and inflammatory markers and preserving left and right ventricle energy metabolites in patients undergoing isolated CABG or aortic valve surgery.
International Standard Randomized Controlled Trial Number (ISRCTN) registry ID 33084113 (doi: 10.1186/ISRCTN33084113) and UK controlled randomized trial number (UKCRN) registry ID 13672.
本试验设计和招募患者的时间正值心脏手术中远程缺血预处理的益处仍存在争议的时候。我们专注于接受单纯主动脉瓣置换术或冠状动脉旁路移植术（CABG）的同质患者人群，以研究心脏损伤、代谢应激和炎症反应。
一项 2 中心随机对照试验于 2013 年 2 月至 2015 年 4 月期间共招募了 124 名患者。其中，64 名患者行 CABG，60 名患者行主动脉瓣置换术。患者随机分为假手术或预处理组。远程缺血预处理在麻醉后和胸骨切开前应用。通过连续测量心肌肌钙蛋白 I 和白细胞介素 6、8、10 和肿瘤坏死因子（TNF-α）来评估心肌损伤和炎症反应。在缺血再灌注损伤后从左心室和右心室采集活检标本进行核苷酸分析。
远程缺血预处理的应用并未改变 CABG 和主动脉瓣置换术组肌钙蛋白 I 释放程度、炎症标志物水平和心脏能量代谢。
在降低 CABG 或主动脉瓣手术患者的肌钙蛋白 I 和炎症标志物水平以及维持左、右心室能量代谢物方面，预处理并未提供任何额外的心脏保护作用。
国际标准随机对照试验编号（ISRCTN）登记号 33084113（doi：10.1186/ISRCTN33084113）和英国对照随机试验编号（UKCRN）登记号 13672。
