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

Figures

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  Figure 1. Study design and patient enrolment. Left column shows RIPC-group, right column shows control group. Exclusion criteria were participation in other trials, body mass index (BMI) > 40 kg/m2, second intervention because of bioprothesis degeneration (“valve-in-valve”), active malignancy with life-expectancy less than 1 year, SIRS or sepsis, cardiogenic shock, dependency on inotropes, peripheral artery disease, thrombosis and chronic renal failure with need for dialysis and dialysis fistula at forearm. BMI = body mass index; SAVR = surgical aortic valve replacement; RIPC = remote ischemic preconditioning.

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  Figure 2. RIPC scheme. Three cycles of ischemia (I) and reperfusion (R) of 5 min each, respectively, were applied, resulting in a total duration of RIPC of 30 min. Efficacy of RIPC was assessed clinically (pulselessness, acrocyanosis, reactive hyperemia). The blood pressure cuff was regularly applied to the right upper arm.

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  Figure 3. Timeline of events. * RIPC group only. RIPC = remote ischemic preconditioning; TAVI = transcatheter aortic valve implantation; TTE = transthoracic echocardiography.

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  Figure 4. Absolute hsTnT concentrations of the RIPC group and matched control group patients. No statistically significant differences between groups with respect to maxima and area under the curves. Values are median (IQR). RIPC = remote ischemic preconditioning.

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  Figure 5. Troponin release according to the type of bioprosthesis. Blue columns show RIPC group, red columns show control group. There was no statistically significant difference between RIPC and non-RIPC patients for either bioprothesis used. Values are median and 95%-CI as error bars. RIPC = remote ischemic preconditioning; AUC = area under the curve.

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  Figure 6. Kaplan–Meier curves for RIPC and matched control group. Blue line shows RIPC group, red line shows control-group. Numbers at risk: time point 0—n = 66 for RIPC and controls; time point 6 months—n = 59 [RIPC], n = 57 [controls]. RIPC = remote ischemic preconditioning; TAVI = transcatheter aortic valve implantation.