• Deok Man Hong, Yunseok Jeon, Chang-Soon Lee, Hyun Joo Kim, Jung-Man Lee, Jae-Hyon Bahk, Ki-Bong Kim, and Ho Young Hwang.
• Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University Hospital, Seoul, Korea.
• Circ. J. 2012 Jan 1;76(4):884-90.

BackgroundMyocardial injury is associated with an adverse outcome after off-pump coronary artery bypass graft surgery (OPCAB). The authors conducted a randomized controlled trial to evaluate whether remote ischemic preconditioning (RIPC) with remote ischemic postconditioning (RIPostC) reduces myocardial injury in patients undergoing OPCAB.Methods And ResultsSeventy patients scheduled for OPCAB were randomly assigned to an RIPC+RIPostC group (n=35) or a control group (n=35). In the RIPC+RIPostC group, 4 cycles of 5-min ischemia and 5-min reperfusion were done on a lower limb before anastomoses (RIPC) and after anastomoses (RIPostC). RIPC+RIPostC significantly reduced postoperative serum troponin I levels (P=0.001). The area under the curve for postoperative troponin I was 48.7% lower in the RIPC+RIPostC group (median [interquartile range], 21.3 h·ng⁻¹·ml⁻¹, 16.5-53.1 h·ng⁻¹·ml⁻¹ vs. 41.5 h·ng⁻¹·ml⁻¹, 24.6-90.2 h·ng⁻¹·ml⁻¹, P=0.020). There was no significant difference in creatinine levels and PaO₂/F(i)O₂ ratios between the 2 groups.ConclusionsRIPC+RIPostC by lower limb ischemia decreased postoperative myocardial enzyme elevation by almost half postoperatively in patients undergoing OPCAB.

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