| Aims The aim of this study was to evaluate whether remote ischemic preconditioning combined with remote ischemic postconditioning (RIPC+RIPostC) reduces ischemia-reperfusion injury of donor hearts in patients undergoing heart transplantation, and whether this method improves the clinical outcomes.Methods Patients undergoing heart transplantation were randomly assigned to either a RIPC+RIPostC group or a control group. Remote ischemic conditioning was applied after anesthesia induction (RIPC) and at 20 minutes after aortic declamping (RIPostC), which consisted of four 5-min cycles of right upper limb ischemia, induced by a cuff inflated to 200 mmHg, with an intervening 5 min of reperfusion during which the cuff was deflated. Serum troponin-I concentration was measured before surgery and at 3,6, 12,24,48, and 72 h after aortic declamping. Postoperative clinical outcomes were recorded, including in-hospital death, new onset stroke, renal failure requiring dialysis, mechanical circulatory support, arrhythmia requiring treatment, re-operation, gastro-intestinal bleeding, mechanical ventilation time, ICU length of stay and postoperative hospital length of stay.Results 60 patients were recruited,30 in RIPC+RIPostC group and 30 in control group. There were no statistical differences in troponin I levels between RIPC+RIPostC and control groups (P>0.05). But in grouping statistics according to donor ischemia time, RIPC+RIPostC significantly reduced serum troponin I levels at 3,6, and 12h after aortic declamping in donor ischemia 6-8h subgroup (P<0.05). The ICU length of stay and postoperative hospital length of stay were shortened significantly in RIPC+RIPostC group compared with control group (P<0.05). RIPC+RIPostC significantly reduced the major organ morbidity and mortality (MOMM).Conclusions Remote ischemic preconditioning combined with remote ischemic postconditioning reduced myocardial injury of donor hearts in patients undergoing heart transplantation, and improved clinical outcomes. |
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