BackgroundThe cardioprotective effect of remote ischemic preconditioning (RIPC) in cardiovascular surgery is controversial. This study investigated whether RIPC combined with remote ischemic postconditioning (RIPostC) reduces myocardial injury to donor hearts in patients undergoing heart transplantation.MethodsOne hundred and twenty patients scheduled for orthotopic heart transplantation were enrolled and randomly assigned to an RIPC+RIPostC group (n=60) or a control (n=60) group. In the RIPC+RIPostC group, after anesthesia induction, four cycles of 5-min of ischemia and 5-min of reperfusion were applied to the right upper limb by a cuff inflated to 200mmHg (RIPC) and 20min after aortic declamping (RIPostC). Serum cardiac troponin I (cTnI) levels were determined preoperatively and at 3, 6, 12, and 24h after aortic declamping. Postoperative clinical outcomes were recorded. The primary endpoint was a comparison of serum cTnI levels at 6h after aortic declamping.ResultsCompared with the preoperative baseline, in both groups, serum cTnI levels peaked at 6h after aortic declamping. Compared with the control group, RIPC+RIPostC significantly reduced serum cTnI levels at 6h after aortic declamping (38.8731.81 vs 69.3034.13ng/ml, P=0.02). There were no significant differences in in-hospital morbidity and mortality between the two groups.Conclusion>In patients undergoing orthotopic heart transplantation, RIPC combined with RIPostC reduced myocardial injury at 6h after aortic declamping, while we found no evidence of this function provided by RIPC+RIPostC could improve clinical outcomes.Trial registrationTrial Registration Number: chictr.org.cn. no. ChiCTR-INR-16010234 (prospectively registered). The initial registration date was 9/1/2017.