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Published on: August 2, 2019
A comparison of cardiac post-conditioning and remote pre-conditioning in paediatric cardiac surgery
Wanjun Luo1, Ming Zhu, Rimao Huang
1Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China. luo3478@yahoo.cn
Insights
Remote ischaemic pre-conditioning and post-conditioning equally protect the heart in children undergoing surgery. Both methods significantly reduced cardiac enzyme release compared to the control group, demonstrating comparable myocardial benefit.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pediatric Cardiac Surgery
Background:
- Remote ischaemic pre-conditioning and cardiac ischaemic post-conditioning are known cardioprotective strategies.
- Direct clinical comparisons between these two endogenous strategies are limited.
- This study focuses on their efficacy in pediatric patients undergoing cardiopulmonary bypass.
Purpose of the Study:
- To compare the effectiveness of remote ischaemic pre-conditioning versus post-conditioning in protecting the myocardium.
- To evaluate myocardial protection in children undergoing surgical repair of ventricular septal defect via cardiopulmonary bypass.
Main Methods:
- 60 pediatric patients undergoing ventricular septal defect repair were randomized into three groups: post-conditioning, remote pre-conditioning, and control.
- Post-conditioning involved repeated aortic clamping/unclamping immediately after cardioplegic arrest.
- Remote pre-conditioning involved repeated lower limb ischemia/reperfusion using a blood-pressure cuff prior to surgery.
Main Results:
- Both post-conditioning and remote pre-conditioning significantly reduced peak release of creatine kinase-MB and troponin I compared to the control group.
- No significant differences were observed in mean age, cardiopulmonary bypass times, or aortic cross-clamp times between groups.
- The reduction in cardiac biomarkers indicated comparable myocardial protection from both interventions.
Conclusions:
- Ischaemic post-conditioning and remote ischaemic pre-conditioning offer comparable myocardial protection in pediatric patients.
- These findings support the use of both techniques in children undergoing cardiopulmonary bypass for ventricular septal defect repair.
- Both methods demonstrate significant cardioprotective effects, reducing myocardial injury markers.
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.
