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To determine whether remote ischaemic preconditioning (RIPC) is cardioprotective in patients undergoing heart valve replacement.Single-blinded, randomised controlled trial.Tertiary referral hospital in China.Adult patients (31–72 years) undergoing mitral valve, aortic valve or tricuspid valve surgery.Patients were randomised to either the RIPC (n=38) or control (n=35) group. After induction of anaesthesia, patients in the RIPC group underwent three 5 min cycles of right upper limb ischaemia, induced by an automated cuff-inflator placed on the upper arm and inflated to 200 mm Hg. Each cycle was interrupted by a 5 min period of reperfusion during which time the cuff was deflated. The control group had only a deflated cuff placed on the upper arm for 30 min.Serum troponin I concentration was measured before surgery and at 6, 12, 24, 48, and 72 h postoperatively. The cardiac function of all patients was followed postoperatively.Troponin I concentration was reduced in the RIPC group (398.7±179.3 μg/l) compared with the control group (708.4±242.5 μg/l). Mean difference was 309.7±50.8 (95% CI 210.1 to 409.3, p<0.0001). A greater improvement in postsurgical cardiac function was noted in the RIPC group than in the control group.These data indicate that RIPC reduces myocardial injury and improves cardiac function in patients undergoing heart valve surgery.NCT01175681.