Abstract | OBJECTIVE: The myocardial protective effect of remote ischemic preconditioning has been demonstrated in heterogeneous groups of patients undergoing cardiac surgery. No studies have examined this technique in neonates. The present study was performed to examine the remote ischemic preconditioning efficacy in this high-risk patient group. METHODS: A preliminary, randomized, controlled trial was conducted to investigate whether remote ischemic preconditioning in cyanosed neonates undergoing cardiac surgery confers protection against cardiopulmonary bypass. Two groups of neonates undergoing cardiac surgery were recruited for the present study: patients with transposition of the great arteries undergoing the arterial switch procedure and patients with hypoplastic left heart syndrome undergoing the Norwood procedure. The subjects were randomized to the remote ischemic preconditioning or sham control groups. Remote ischemic preconditioning was induced by four 5-minute cycles of lower limb ischemia and reperfusion using a blood pressure cuff. Troponin I and the biomarkers for renal and cerebral injury were measured pre- and postoperatively. RESULTS: CONCLUSIONS: Our data suggest that remote ischemic preconditioning in hypoxic neonates undergoing cardiopulmonary bypass surgery does not provide myocardial, renal, or neuronal protection. Additional studies are needed to examine the relationships among developmental age, hypoxia, and the molecular mechanisms of ischemic preconditioning.
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Authors | Bryn O Jones, Salvatore Pepe, Freya L Sheeran, Susan Donath, Pollyanna Hardy, Lara Shekerdemian, Daniel J Penny, Ian McKenzie, Stephen Horton, Christian P Brizard, Yves d'Udekem, Igor E Konstantinov, Michael M H Cheung |
Journal | The Journal of thoracic and cardiovascular surgery
(J Thorac Cardiovasc Surg)
Vol. 146
Issue 6
Pg. 1334-40
(Dec 2013)
ISSN: 1097-685X [Electronic] United States |
PMID | 23414626
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Chemical References |
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Topics |
- Biomarkers
(blood)
- Cardiac Surgical Procedures
(adverse effects)
- Cardiopulmonary Bypass
(adverse effects)
- Cyanosis
(etiology)
- Humans
- Hypoplastic Left Heart Syndrome
(complications, diagnosis, surgery)
- Infant, Newborn
- Ischemic Preconditioning
(adverse effects, methods)
- Lower Extremity
(blood supply)
- Norwood Procedures
- Postoperative Complications
(blood, etiology)
- Regional Blood Flow
- Time Factors
- Tourniquets
- Transposition of Great Vessels
(complications, diagnosis, surgery)
- Treatment Outcome
- Troponin I
(blood)
- Victoria
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