Cardioprotective effect of remote ischemic postconditioning on children undergoing cardiac surgery: a randomized controlled trial

Abstract

Remote ischemic postconditioning (RPostC) is a noninvasive intervention that has demonstrated cardioprotection and neuroprotection in animal studies. Our goal was to investigate the cardio-cerebral protective effects of RPostC on children undergoing open-heart surgery for repair of congenital heart defects (CHD). Children undergoing open-heart repair of CHD were randomly assigned to a RPostC or control group. RPostC was induced by three 5-min cycles of lower limb ischemia and reperfusion using a blood pressure cuff (200mmHg) at the onset of aortic unclamping. Serum cardiac troponin I (cTnI), creatine kinase-MB (CK-MB), neuron-specific enolase (NSE), S100β, cytokines, and clinical outcomes were assessed. There were 35 children in the control group and 34 in the RPostC group. The mean age (3.64±1.95years vs. 3.45±3.02years, P=0.80), weight (15.11±6.91kg vs. 13.40±6.33kg, P=0.37), surgical time (144.82±38.51min vs. 129.92±30.76min, P=0.15), and bypass time (78.01±27.22min vs. 72.52±26.05min, P=0.49) were not different. Compared with the control group, the postoperative levels of cTnI (P=0.037) and CK-MB (P=0.046) were significantly reduced in the RPostC group. Furthermore, the MAP was higher (P=0.008), and ICU stay (36.87±3.30h vs. 60.57±7.35h, P=0.006) and postoperative hospital stay (8.56±1.50days vs. 10.06±2.41days, P=0.048) were shorter in the RPostC group than in the control group. However, the postoperative CVP and the concentrations of NSE, S100β, CRP, TNF-α, IL-1β, IL-6, and IL-10 were not significantly different. RPostC significantly alleviates cardiac injury in children undergoing open-heart repair of CHD and may also reduce cerebral injury.