Remote Ischemic Preconditioning Neither Improves Survival nor Reduces Myocardial or Kidney Injury in Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI)

• Main Authors: Mandy Flechsig, Tobias F. Ruf, Willi Troeger, Stephan Wiedemann, Silvio Quick, Karim Ibrahim, Christian Pfluecke, Akram Youssef, Krunoslav M. Sveric, Robert Winzer, Frank R. Heinzel, Axel Linke, Ruth H. Strasser, Kun Zhang, Felix M. Heidrich
• Format: Article
• Language: English
• Published: MDPI AG 2020-01-01
• Series: Journal of Clinical Medicine
• Subjects: aortic valve stenosis; transcatheter aortic valve replacement; ischemic preconditioning; bioprosthesis
• Online Access: https://www.mdpi.com/2077-0383/9/1/160

Background: Peri-interventional myocardial injury occurs frequently during transcatheter aortic valve implantation (TAVI). We assessed the effect of remote ischemic preconditioning (RIPC) on myocardial injury, acute kidney injury (AKIN) and 6-month mortality in patients undergoing TAVI. Methods: We performed a prospective single-center controlled trial. Sixty-six patients treated with RIPC prior to TAVI were enrolled in the study and were matched to a control group by propensity-score. RIPC was applied to the upper extremity using a conventional tourniquet. Myocardial injury was assessed using high-sensitive troponin-T (hsTnT), and kidney injury was assessed using serum creatinine levels. Data were compared with the Wilcoxon-Rank and McNemar tests. Mortality was analysed with the log-rank test. Results: TAVI led to a significant rise of hsTnT across all patients (<i>p</i> &lt; 0.001). No significant inter-group difference in maximum troponin release or areas-under-the-curve was detected. Medtronic CoreValve and Edwards Sapien valves showed similar peri-interventional troponin kinetics and patients receiving neither valve did benefit from RIPC. AKIN occurred in one RIPC patient and four non-RIPC patients (<i>p</i> = 0.250). No significant difference in 6-month mortality was observed. No adverse events related to RIPC were recorded. Conclusion: Our data do not show a beneficial role of RIPC in TAVI patients for cardio- or renoprotection, or improved survival.