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

Patrick Meybohm, Madeline Kohlhaas, Christian Stoppe, Matthias Gruenewald, Jochen Renner, Berthold Bein, Martin Albrecht, Jochen Cremer, Mark Coburn, Gereon Schaelte, Andreas Boening, Bernd Niemann, Michael Sander, Jan Roesner, Frank Kletzin, Haitham Mutlak, Sabine Westphal, Rita Laufenberg-Feldmann, Marion Ferner, Ivo F Brandes, Martin Bauer, Sebastian N Stehr, Andreas Kortgen, Maria Wittmann, Georg Baumgarten, Tanja Meyer-Treschan, Peter Kienbaum, Matthias Heringlake, Julika Schoen, Sascha Treskatsch, Thorsten Smul, Ewa Wolwender, Thomas Schilling, Georg Fuernau, Holger Bogatsch, Oana Brosteanu, Dirk Hasenclever, Kai Zacharowski, RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study Collaborators, Ana Stevanovic, Rolf Rossaint, Marc Felzen, Andreas Goetzenich, Tobias Moormann, Katharina Chalk, Pascal Knuefermann, Thomas Recht, Andreas Hoeft, Michael Winterhalter, Sonja Iken, Carolin Wiedenbeck, Gerhard Schwarzmann, Simone Lindau, Andreas Zierer, Stephan Fichtlscherer, Gerold Goerlach, Matthias Wollbrueck, Ursula Boening, Markus Weigand, Julia Strauchmann, Kai U Morsbach, Markus Paxian, Konrad Reinhard, Jens Scholz, Jochen Renner, Ole Broch, Helga Francksen, Bernd Kuhr, Hermann Heinze, Hauke Paarmann, Hans-Hinrich Sievers, Stefan Klotz, Thomas Hachenberg, Christian Werner, Susanne Mauff, Angela Alms, Stefan Bergt, Norbert Roewer, Patrick Meybohm, Madeline Kohlhaas, Christian Stoppe, Matthias Gruenewald, Jochen Renner, Berthold Bein, Martin Albrecht, Jochen Cremer, Mark Coburn, Gereon Schaelte, Andreas Boening, Bernd Niemann, Michael Sander, Jan Roesner, Frank Kletzin, Haitham Mutlak, Sabine Westphal, Rita Laufenberg-Feldmann, Marion Ferner, Ivo F Brandes, Martin Bauer, Sebastian N Stehr, Andreas Kortgen, Maria Wittmann, Georg Baumgarten, Tanja Meyer-Treschan, Peter Kienbaum, Matthias Heringlake, Julika Schoen, Sascha Treskatsch, Thorsten Smul, Ewa Wolwender, Thomas Schilling, Georg Fuernau, Holger Bogatsch, Oana Brosteanu, Dirk Hasenclever, Kai Zacharowski, RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study Collaborators, Ana Stevanovic, Rolf Rossaint, Marc Felzen, Andreas Goetzenich, Tobias Moormann, Katharina Chalk, Pascal Knuefermann, Thomas Recht, Andreas Hoeft, Michael Winterhalter, Sonja Iken, Carolin Wiedenbeck, Gerhard Schwarzmann, Simone Lindau, Andreas Zierer, Stephan Fichtlscherer, Gerold Goerlach, Matthias Wollbrueck, Ursula Boening, Markus Weigand, Julia Strauchmann, Kai U Morsbach, Markus Paxian, Konrad Reinhard, Jens Scholz, Jochen Renner, Ole Broch, Helga Francksen, Bernd Kuhr, Hermann Heinze, Hauke Paarmann, Hans-Hinrich Sievers, Stefan Klotz, Thomas Hachenberg, Christian Werner, Susanne Mauff, Angela Alms, Stefan Bergt, Norbert Roewer

Abstract

Background: Remote ischemic preconditioning (RIPC) has been suggested to protect against certain forms of organ injury after cardiac surgery. Previously, we reported the main results of RIPHeart (Remote Ischemic Preconditioning for Heart Surgery) Study, a multicenter trial randomizing 1403 cardiac surgery patients receiving either RIPC or sham-RIPC.

Methods and results: In this follow-up paper, we present 1-year follow-up of the composite primary end point and its individual components (all-cause mortality, myocardial infarction, stroke and acute renal failure), in a sub-group of patients, intraoperative myocardial dysfunction assessed by transesophageal echocardiography and the incidence of postoperative neurocognitive dysfunction 5 to 7 days and 3 months after surgery. RIPC neither showed any beneficial effect on the 1-year composite primary end point (RIPC versus sham-RIPC 16.4% versus 16.9%) and its individual components (all-cause mortality [3.4% versus 2.5%], myocardial infarction [7.0% versus 9.4%], stroke [2.2% versus 3.1%], acute renal failure [7.0% versus 5.7%]) nor improved intraoperative myocardial dysfunction or incidence of postoperative neurocognitive dysfunction 5 to 7 days (67 [47.5%] versus 71 [53.8%] patients) and 3 months after surgery (17 [27.9%] versus 18 [27.7%] patients), respectively.

Conclusions: Similar to our main study, RIPC had no effect on intraoperative myocardial dysfunction, neurocognitive function and long-term outcome in cardiac surgery patients undergoing propofol anesthesia.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01067703.

Keywords: cardio‐vascular surgery; ischemia/reperfusion injury; remote ischemic preconditioning.

© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
Kaplan–Meier‐plots of proportion event‐free time to primary end point. Kaplan–Meier‐Plots are shown for the two intervention groups. Event‐free survival did not differ significantly between the two intervention groups (Cox regression analysis, with adjustment for the stratification variables). RIPC indicates remote ischemic preconditioning.

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