Effect of remote ischemic perconditioning on systemic inflammatory response in patients undergoing cardiac valve replacement with cardiopulmonary bypass

Abstract

Objective To evaluate the effect of remote ischemic perconditioning on systemic inflammatory response in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty adult patients undergoing cardiac valve replacement under CPB were randomly divided into 2 groups (n =20 each):control group (group C) and remote ischemic preconditioning group (group R).Anesthesia was induced with iv injection of midazolam,fentanyl,vecuronium.The patients were mechanically ventilated after endotracheal intubation.Anesthesia was maintained with iv injection of midazolam,fentanyl,vecuronium and inhalation of sevoflurane.Three cycles of 5-min ischemia and 5-rmin reperfusion were performed on the fight lower extremity immediately after aortic occlusion by means of a tourniquet in group R.A tourniquet was only placed under the right lower extremity in group C.Before CPB and at 0,6 and 24 h after termination of CPB (T1-4),blood samples were obtained from the right internal jugular vein for determination of levels of serum intercellular adhesion molecule-1 (ICAM-1),IL-6 and TNF-α.Results The levels of serum ICAM-1,IL-6 and TNF-α were significantly lower in group R than in group C (P ＜ 0.05).Compared with the baseline value at T1,the levels of serum ICAM-1,IL-6 and TNF-α were significantly increased at T2 and T3 in both groups,serum ICAM-1 and IL-6 levels were increased at T4 in group C,while serum IL-6 level was increased at T4 in group R (P ＜ 0.05).The levels of serum ICAM-1,IL-6 and TNF-α were significantly decreased at T3 and T4 than at T2 in both group (P ＜ 0.05).The levels of serum ICAM-1,IL-6 and TNF-α were significantly lower at T4 than at T3 in both groups (P ＜ 0.05).Conclusion Remote ischemic perconditioning can alleviate the systemic inflammatory response in patients undergoing cardiac valve replacement with CPB. Key words: Extracorporeal circulation; Systemic inflammatory response syndrome; Remote ischemic perconditioning