Can human myocardium be remotely preconditioned? The results of a randomized controlled trial

• Published in: European journal of cardio-thoracic surgery 2019-06, Vol.55 (6), p.1086-1094
• Main Authors: Deja, Marek A, Piekarska, Magda, Malinowski, Marcin, Wiaderkiewicz, Ryszard, Czekaj, Piotr, Machej, Leszek, Węglarzy, Andrzej, Kowalówka, Adam, Kołodziej, Tadeusz, Czech, Ewa, Plewka, Danuta, Mizia, Magdalena, Latusek, Tomasz, Szurlej, Bartosz
• Format: Article
• Language: English
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezy441

Abstract OBJECTIVES No experimental study has shown that the myocardium of a remotely preconditioned patient is more resistant to a standardized ischaemic/hypoxic insult. METHODS This was a single-centre randomized (1:1), double-blinded, sham-controlled, parallel-group study. Patients referred for elective coronary bypass surgery were allocated to either remote ischaemic preconditioning (3 cycles of 5-min ischaemia/5-min reperfusion of the right arm using a blood pressure cuff inflated to 200 mmHg) or sham intervention. One hundred and thirty-four patients were recruited, of whom 10 dropped out, and 4 were excluded from the per-protocol analysis. The right atrial trabecula harvested on cannulation for cardiopulmonary bypass was subjected to 60 min of simulated ischaemia and 120 min of reoxygenation in an isolated organ experiment. Postoperative troponin T release and haemodynamics were assessed in an in vivo study. RESULTS The atrial trabeculae obtained from remotely preconditioned patients recovered 41.9% (36.3–48.3) of the initial contraction force, whereas those from non-preconditioned patients recovered 45.9% (39.1–53.7) (P = 0.399). Overall, the content of cleaved poly (ADP ribose) polymerase in the right atrial muscle increased from 9.4% (6.0–13.5) to 19.1% (13.2–23.8) (P