Late remote ischemic preconditioning in children undergoing cardiopulmonary bypass: A randomized controlled trial

Author(s)

Pavione, Marcos A. ^[1] ; Carmona, Fabio ^[1] ; de Castro, Margaret ^[2] ; Carlotti, Ana P. C. P. ^[1]

Affiliation

^[1] Univ Sao Paulo, Hosp Clin, Fac Med Ribeirao Preto, Div Pediat Crit Care Med, Dept Pediat, BR-14049900 Ribeirao Preto, SP - Brazil

^[2] Univ Sao Paulo, Hosp Clin, Fac Med Ribeirao Preto, Div Endocrinol, Dept Internal Med, BR-14049900 Ribeirao Preto, SP - Brazil

• Document type: Journal article
• Source: JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY; v. 144, n. 1, p. 178+, JUL 2012.
• Web of Science Citations: 34

Abstract

Objective: Cardiopulmonary bypass is associated with ischemia-reperfusion injury to multiple organs. We aimed to evaluate whether remote ischemic preconditioning performed the day before surgery for congenital heart disease with cardiopulmonary bypass attenuates the postoperative inflammatory response and myocardial dysfunction. Methods: This was a prospective, randomized, single-blind, controlled trial. Children allocated to remote ischemic preconditioning underwent 4 periods of 5 minutes of lower limb ischemia by a blood pressure cuff intercalated with 5 minutes of reperfusion. Blood samples were collected 4, 12, 24, and 48 hours after cardiopulmonary bypass to evaluate nuclear factor kappa B activation in leukocytes by quantification of mRNA of I kappa B alpha by real-time quantitative polymerase chain reaction and for interleukin-8 and 10 plasma concentration measurements by enzyme-linked immunosorbent assay. Myocardial dysfunction was assessed by N-terminal pro-B-type natriuretic peptide and cardiac troponin I plasma concentrations, measured by chemiluminescence, and clinical parameters of low cardiac output syndrome. Results: Twelve children were allocated to remote ischemic preconditioning, and 10 children were allocated to the control group. Demographic data and Risk Adjustment for Congenital Heart Surgery 1 classification were comparable in both groups. Remote ischemic preconditioning group had lower postoperative values of N-terminal pro-B-type natriuretic peptide, but cardiac troponin I levels were not significantly different between groups. Interleukin-8 and 10 concentrations and I kappa B alpha gene expression were similar in both groups. Postoperative morbidity was similar in both groups; there were no postoperative deaths in either group. Conclusions: Late remote ischemic preconditioning did not provide clinically relevant cardioprotection to children undergoing cardiopulmonary bypass. (J Thorac Cardiovasc Surg 2012;144:178-83) (AU)

• FAPESP's process: 08/05067-8 - Assessment of the use of remote ischemic preconditioning on the day before surgery in children undergoing cardiopulmonary bypass (second window effects)
• Grantee: Ana Paula de Carvalho Panzeri Carlotti
• Support Opportunities: Regular Research Grants