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Abstract The current study is a single center prospective comparative clinical study between the effect of infusion of terminal warm reperfusion (substitute of hot shot) before removal of the aortic cross clamp, the effect of remote ischaemic preconditioning and the effect of both techniques together on myocardial recovery in elective adult cardiac surgery. The current study was conducted at the cardiothoracic surgery department Tanta university hospital from October 2014 to March 2017. A total number of 145 patients were enrolled in the study; all the included patients were selected according to the inclusion and exclusion criteria that were mentioned in the study protocol. Four groups were fashioned the control group included 37 patients who didn’t receive the substitute of hot shot or the remote ischemic conditioning, the substitute of hot shot group included 36 patients who received the terminal substitute of hot shot before removal of the aortic cross clamp, the remote ischemic preconditioning group included 36 patients who received remote ischemic preconditioning at the time of induction of general anaesthesia and the combined group included 36 patients who received both terminal substitute to hot shot and remote ischemic preconditioning. The preoperative, intra-operative and the postoperative patient data were collected, registered, tabulated and statistically analyzed |