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Publication - Professor Costanza Emanueli

    Remote ischaemic preconditioning in isolated aortic valve and coronary artery bypass surgery

    a randomized trial


    Moscarelli, M, Fiorentino, F, Suleiman, M-S, Emanueli, C, Reeves, B, Punjabi, P & Angelini, G, 2019, ‘Remote ischaemic preconditioning in isolated aortic valve and coronary artery bypass surgery: a randomized trial’. European Journal of Cardio-Thoracic Surgery, vol 55., pp. 905-912


    Objective: This trial was designed and started recruiting at a time when the benefits of remote ischemic preconditioning during open-heart surgery were still controversial. We focused on a homogeneous patient’s population undergoing either isolated aortic valve replacement (AVR) or coronary artery bypass graft surgery (CABG) by investigating cardiac injury, metabolic stress and inflammatory response.

    Methods: A two-centre randomised controlled trial recruited a total of 124 patients between February 2013 and April 2015. Of these 64 patients underwent CABG and 60 patients AVR. Patients were randomized to either sham or preconditioning. Remote ischemic preconditioning was applied following anesthesia and before sternotomy. Myocardial injury and inflammatory response were assessed by serially measuring cardiac troponin I, and IL-6, 8, 10 and TNF-α. Biopsies from left and right ventricles were harvested after ischemic reperfusion injury for nucleotides analysis.

    Results: Application of remote ischemic preconditioning did not alter troponin I release, levels of inflammatory markers and cardiac energetics in both CABG or AVR groups.

    Conclusions: Preconditioning did not confer any additional cardioprotection in terms of troponin I, inflammatory markers reduction, and left and right ventricle energy metabolites preservation in patients undergoing isolated coronary artery bypass grafting or aortic valve surgery.

    Full details in the University publications repository