A comparison of cardiac post-conditioning and remote pre-conditioning in paediatric cardiac surgery.

Abstract

BACKGROUND:

Remote ischaemic pre-conditioning and cardiac ischaemic post-conditioning provide myocardial protection in cardiac surgery. However, these two endogenous strategies have not been directly compared in a clinical setting. The purpose of this study was to compare the efficacy of remote ischaemic pre-conditioning and post-conditioning in providing myocardial protection to children undergoing cardiopulmonary bypass for surgical repair of ventricular septal defect.

METHODS:

We randomly assigned 60 paediatric patients scheduled for surgical correction of congenital ventricular septal defect to the post-conditioning group (n = 20), remote pre-conditioning group (n = 20), or control group (n = 20). Post-conditioning consisted of 30 seconds of ischaemia and 30 seconds of reperfusion achieved by clamping and unclamping the aorta, repeated three times over 3 minutes immediately after cardioplegic arrest. Remote ischaemic pre-conditioning consisted of 5 minutes of lower limb ischaemia followed by 5 minutes of reperfusion using a blood-pressure cuff inflated to a pressure of 200 millimetres of mercury, also repeated three times over 30 minutes. We assayed creatine kinase-MB, troponin I.

RESULTS:

Mean age, cardiopulmonary bypass times, and aortic cross-clamp times were matched across groups. Both post-conditioning and remote ischaemic pre-conditioning reduced the peak release of creatine kinase-MB (86.1 plus or minus 24.1 units per litre and 92.8 plus or minus 20.6 units per litre, respectively, versus 111.0 plus or minus 44.6 units per litre in the control, p less than 0.05) and troponin I (0.28 plus or minus 0.10 nanogram per millilitre and 0.26 plus or minus 0.09 nanogram per millilitre, respectively, versus 0.49 plus or minus 0.19 nanogram per millilitre in the control group, p less than 0.05).

CONCLUSIONS:

Our study demonstrates that ischaemic post-conditioning and remote ischaemic pre-conditioning provide comparable myocardial benefit in children undergoing cold blood cardioplegic arrest.

• Authors: Wanjun Luo, Ming Zhu, Rimao Huang, Yangde Zhang
• Journal: Cardiology in the young (Cardiol Young) Vol. 21 Issue 3 Pg. 266-70 (Jun 2011) ISSN: 1467-1107 [Electronic] England
• PMID: 21262079 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Troponin I
• Creatine Kinase

Topics

• Cardiopulmonary Bypass (methods)
• Cardiovascular Surgical Procedures (methods)
• Child, Preschool
• China
• Coronary Vessels
• Creatine Kinase (blood)
• Female
• Heart Septal Defects, Ventricular (surgery)
• Humans
• Infant
• Ischemic Postconditioning (methods)
• Ischemic Preconditioning, Myocardial (methods)
• Male
• Myocardial Reperfusion Injury (prevention & control)
• Pediatrics
• Treatment Outcome
• Troponin I (blood)