Implications of Remote Ischemic Preconditioning on Liver Function in Adults Undergoing Cardiac Surgery: Randomized Controlled Trial

Abstract

Background: Many therapeutic strategies for protection against ischemic reperfusion and one of them is Remote ischemic preconditioning (RIPC) which is an alternative to ischemic conditioning but it has not yet been extensively studied. While RIPC may attenuate myocardial injury during cardiac surgery, its beneficial effects on different organs are still unclear. We hypothesized that RIPC would improve postoperative liver function in adults undergoing cardiac surgery.

Materials and Methods: 90  patients undergoing on-pump cardiac surgery were randomly assigned to two groups. Group A (study group, 45 patients) received RIPC, while Group B (control group, 45 patients) received a pseudo-RIPC. The primary outcome was RIPC  on liver function, while secondary outcome was its effect on renal function.

Results: There was an insignificant difference between the two groups regarding the primary outcome, measured by liver function tests (Alanine aminotransferase (ALT)- Aspartate aminotransferase (AST)-Alkaline Phosphatase (ALP), albumin, Bilirubin (total, direct, and indirect) or clinical indicators such as jaundice, encephalopathy, and bleeding tendency. With respect to renal function, there was an insignificant difference in serum level of blood urea nitrogen (BUN) and creatinine between the two groups, except for on the 3rd postoperative day as serum creatinine and BUN were significantly lower in the RIPC group.

Conclusions: Our study demonstrates that in adults undergoing on-pump cardiac surgery, RIPC did not provide a significant beneficial effect in terms of liver or renal function outcomes, except for significantly lower kidney function tests in the RIPC group on day three postoperatively.