Effect of terminal warm reperfusion (hot shot) and remote ischemic preconditioning, either separately or combined, on myocardial recovery in adult cardiac surgery

Background: Reperfusion injury is a major contributor to morbidity and mortality after cardiac surgery. Among the myocardial protective modalities, terminal warm reperfusion (hot shot) and remote ischemic pre-conditioning techniques were found to protect myocardial function and improve better postoperative outcomes. The aim of this study was to compare the effect of terminal hot shot cardioplegia, the effect of remote ischemic preconditioning and the effect of both techniques on myocardial recovery after adult cardiac surgery.Methods: One hundred forty-five patients were divided into four groups comparing hot shot group, remote ischemic preconditioning group, combined hot shot and remote ischemic preconditioning group and the control group. The data collected included preoperative demographic and clinical characteristics, intraoperative data and postoperative short term outcome including inhospital mortality.Results: Patients of the combined group were found to have significantly better outcome including fewer ventricular arrhythmias, less intra-operative need of intra-aortic balloon pump, low cardiac output, and less length of ICU stay. The in-hospital mortality showed a significant difference between the 4 groups. Among patients without hot shot, the incidence of postoperative temporary epicardial pacing was higher and decreased in patients underwent hot shot and remote ischemic preconditioning but didn't reach a statistical significance.Conclusions: Both remote ischemic preconditioning and terminal hot shot reperfusion before removal of the aortic cross clamping improved outcome of on-pump adult cardiac surgery patients. There was a significant effect on the in-hospital mortality and there were fewer incidences of arrhythmias and less requirement for postoperative inotropic support with this technique