Cardiac function is crucial for cardiac surgery. Unfortunately, mortality remains very

high in patients with poor preoperative cardiac function, long surgical times, complicated

or difficult surgical procedures, or incomplete correction of the malformation. It is

therefore necessary to find novel approaches to improve cardiac function for cardiac

surgery patients in order to simultaneously increase success rates and decrease

complications and mortality.1 When the coronary circulation is interrupted, the size of the

resulting infarct is proportional to the duration of ischemia.2 Paradoxically, even early

revascularization leads to tissue damage, a phenomenon known as ischemia reperfusion

injury,3 which is estimated to be responsible for up to 30% of infarct size.4 This has

prompted a search for cytoprotective mechanisms that make the myocardium less

vulnerable to such damage, not only in acute settings (as in revascularization in the

context of acute coronary syndrome [ACS]) but also following surgical procedures that

entail temporary interruption of the coronary circulation, particularly cardiac surgery with

aortic clamping and heart transplantation.5 Inducing non-lethal and brief ischemia before

the period of prolonged ischemia has been considered as a tool for increasing the heart’s

resistance to ischemia-reperfusion (I/R) injury.6,7 Subsequently, preconditioning the heart

with ischemia was shown to maintain its cardioprotective abilities even if the non-lethal

ischemic stimulus was applied not directly to the targeted tissue, but to any distant site of

the organism – hence the idea of remote ischemic preconditioning (RIPC).8 In cardiac

surgery, where the timing of global ischemia and reperfusion periods is predictable, the

application of RIPC seemed a perfect solution.9 This technique was used in patients for

the first time in children undergoing corrective surgery for congenital heart disease, in

whom it was shown to reduce troponin release 24 h postoperatively.10The aim of this

study was to determine if RIPC could induce myocardial protection in single valve

replacement patients. We conducted a randomised controlled clinical trial in which RIPC

was induced by upper limb brief ischemia and reperfusion using blood pressure cuff

inflation. Myocardial injury was evaluated by postoperative serum troponin levels and

compared between the RIPC and control groups.