Effect of remote ischemic preconditioning on cognitive function after off-pump coronary artery bypass graft: a pilot study

Abstract

BackgroundSeveral studies have shown in animal models that remote ischemic preconditioning (rIPC) has a neuroprotective effect. However, a randomized controlled trial in human subjects to investigate the neuroprotective effect of rIPC after cardiac surgery has not yet been reported. Therefore, we performed this pilot study to determine whether rIPC reduced the occurrence of postoperative cognitive dysfunction in patients who underwent off-pump coronary artery bypass graft (OPCAB) surgery.MethodsSeventy patients who underwent OPCAB surgery were assigned to either the control or the rIPC group using a computer-generated randomization table. The application of rIPC consisted of four cycles of 5 min ischemia and 5 min reperfusion on an upper limb using a blood pressure cuff inflating 200 mmHg before coronary artery anastomosis. The cognitive function tests were performed one day before surgery and again on postoperative day 7. We defined postoperative cognitive dysfunction as decreased postoperative test values more than 20% of the baseline values in more than two of the six cognitive function tests that were performed.ResultsIn the cognitive function tests, there were no significant differences in the results obtained during the preoperative and postoperative periods for all tests and there were no mean differences observed in the preoperative and postoperative scores. The incidences of postoperative cognitive dysfunction in the control and rIPC groups were 28.6% (10 patients) and 31.4% (11 patients), respectively.ConclusionsrIPC did not reduce the incidence of postoperative cognitive dysfunction after OPCAB surgery during the immediate postoperative period.

RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study: Myocardial Dysfunction, Postoperative Neurocognitive Dysfunction, and 1 Year Follow‐Up

“…RIPC did not reduce the incidence of POCD in the immediate postoperative period (28.6% [n=10] in the control versus 31.4% [n=11] in the RIPC group). 40 In conclusion, RIPC had no beneficial effect on 1-year follow-up, intraoperative myocardial dysfunction and postoperative neurocognitive dysfunction in cardiac surgery patients undergoing propofol-based anesthesia.…”

“…Joung et al evaluated the effect of RIPC on POCD in 70 patients who underwent off‐pump coronary artery bypass graft surgery. RIPC did not reduce the incidence of POCD in the immediate postoperative period (28.6% [n=10] in the control versus 31.4% [n=11] in the RIPC group) …”

Safety and Efficacy of Remote Ischemic Preconditioning in Patients With Severe Carotid Artery Stenosis Before Carotid Artery Stenting

“…However, in a pilot study, RIPC did not improve cognition function after off-pump coronary artery bypass graft surgery. 35 Whether RIPC is a viable strategy to prevent cognitive decline after major surgery needs to be further investigated.…”

A Multicenter Trial of Remote Ischemic Preconditioning for Heart Surgery

“…[5][6][7][8][9][10] Only a few studies have included clinical outcomes as primary end points, and most are limited by small samples. 4,6,[11][12][13] Thus, a large, randomized study would be helpful to elucidate the role of this simple intervention in daily practice. We hypothesized that RIPC would improve clinical outcomes in patients undergoing elective cardiac surgery.…”