Cardioprotective effect of remote ischemic preconditioning (RIPC) in patients undergoing aortic valve replacement

The purpose of our study is to investigate cardioprotective effect of remote ischemic preconditioning in patients undergoing aortic valve replacement under different methods of anaesthesia. Materials and methods. 27 adult patients aged from 50 to 75 years old (63 (56;68)) who had been scheduled for aortic valve replacement with CPB were involved in prospective randomized study. All of the patients signed informed consent form to take part in the study. There were 4 groups of patients: in 1st group we administered RIPC during propofol-fentanyl anaesthesia (RIPC-propofol group, n=8); in 2nd group RIPC was administered during sevoflurane-fentanyl anaesthesia (RIPC-sevoflurane group, n=5); in 3rd group we used propofol-fentanyl anaesthesia without RIPC(control- propofol group, n=7) and in 4th group sevoflurane-propofol anaesthesia was used only (control-sevoflurane group, n=7). Troponine I level (cTrI) was assessed at following time points: after induction of anaesthesia, after 30 min, 12, 24 and 48 hours after CPB termination. Statistical analysis was performed by Statistica 10.0 (Statsoft Inc.,USA). Considering small sample size and nonnormal data distribution, groups comparisons were analyzed by Mann-Whitney U-test. Critical level p<0.05 was significant. Data is presented as median (25th; 75th percentile). Results. We found no significant differences in cTnI between control and RIPC groups at any time point of our study. Analysing cTnI in sevoflurane-based anaesthesia cases, statistically significant data was observed at 24 and 48-time point between RIPC-sevoflurane and control-sevoflurane group: RIPC-sevoflurane group 1.58 (1.55; 2.15) ng/ml, control-sevoflurane group 5.46 (4.05; 6.49) ng/ml at 24 hours, p=0.03. RIPC-sevoflurane 1.4 (1.34; 4.52) ng/ml, control-sevoflurane 3.23 (2.95; 3.64) ng/ml at 48 hours p=0.02. Futhermore, we found difference in cTnI area under curve (AUC): RIPC-sevoflurane 69.0 (65.8; 97.5) ng/ml/48h, control-sevoflurane 250.9 (250.4; 296.6) ng/ml/48 h, p=0.02. Conclusions. Cardioprotective effect of RIPC should be assessed according to used method of anaesthesia. RIPC in coupe with sevoflurane-based anaesthesia decreases myocardium injury in patients undergoing aortic valve replacement.

дистантное ишемическое прекондиционирование, тропонин I, кардиохирургия, remote ischemic preconditioning, troponine I, cardiosurgery

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