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BACKGROUND: Remote ischemic preconditioning (RIPC) has been proven by many studies as beneficial for patients undergoing cardiac surgery. There are not enough evidence to include this method to standardised patient care. Aim of this study is to assess whether routine RIPC reduces myocardial injury in off-pump coronary artery bypass grafting surgery (OPCAB).
METHODS: 30 consecutive adults undergoing elective OPCAB were randomly assigned to RIPC group (n=15) or to a control group (n=15). RIPC was applied after induction of anaesthesia and consisted of three 5-min cycles of right upper limb ischemia, induced by manual cuff-inflator inflated to 200 mmHg, placed on the right upper arm with an intervening reperfusion period of 5 min when the cuff was deflated. Myocardial cell damage was assessed by serum troponin I (cTnI) and creatine kinase MB (CKMB) measured at induction and 6, 12, 24 hours postoperatively.
RESULTS: In RIPC group cTnI at 6, 12 and 24 h after surgery were significantly lower (p<0.001) than in control group. Also CKMB at 6, 12 and 24 h postoperatively in RIPC group were significantly lower ( p<0.05) than in control group.
CONCLUSIONS:In this pilot study we provide clinical evidence, suggesting that RIPC phenomenon may represent a simple, inexpensive, easily applied cardioprotective method during OPCAB.

results

	RIPC mean (SD)	control mean (SD)	p-value
cTnI 06h (ng • ml -1)	0.78 (0.55)	3.56 (1.89)	p <0.001
cTnI 12h (ng • ml -1)	0.66 (0.44)	3.38 (2.39)	p <0.001
cTnI 24h (ng • ml -1)	0.42 (0.23)	2.33 (1.77)	p <0.001
CKMB 06h (U • l -1)	9.72 (4.42)	16.93 (4.51)	p <0.001
CKMB 12h (U • l -1)	12.13 (6.46)	23.07 (10.17)	p <0.05
CKMB 24h (U • l -1)	10.60 (5.63)	18.93 (9.03)	p <0.05