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.
RCT Entities:
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.
Authors: Gerd Heusch; Hans Erik Bøtker; Karin Przyklenk; Andrew Redington; Derek Yellon Journal: J Am Coll Cardiol Date: 2015-01-20 Impact factor: 24.094
Authors: Theo P Menting; Kimberley E Wever; Denise Md Ozdemir-van Brunschot; Daan Ja Van der Vliet; Maroeska M Rovers; Michiel C Warle Journal: Cochrane Database Syst Rev Date: 2017-03-04
Authors: Jesse A Davidson; Tracy T Urban; Christine Baird; Suhong Tong; Alan Woodruff; Mark Twite; James Jaggers; Eric A F Simões; Paul Wischmeyer Journal: J Pediatr Date: 2017-11 Impact factor: 4.406
Authors: Salvatore Pepe; Norman Y Liaw; Michele Hepponstall; Freya L Sheeran; Matthew S Yong; Yves d'Udekem; Michael M Cheung; Igor E Konstantinov Journal: J Am Heart Assoc Date: 2013-05-10 Impact factor: 5.501
Authors: Robert Wagner; Pavel Piler; Zufar Gabbasov; Junko Maruyama; Kazuo Maruyama; Jiri Nicovsky; Peter Kruzliak Journal: Biomed Res Int Date: 2014-08-19 Impact factor: 3.411
Authors: Brian W McCrindle; Nadia A Clarizia; Svetlana Khaikin; Helen M Holtby; Cedric Manlhiot; Steven M Schwartz; Christopher A Caldarone; John G Coles; Glen S Van Arsdell; Stephen W Scherer; Andrew N Redington Journal: J Am Heart Assoc Date: 2014-07-28 Impact factor: 5.501
Authors: Jesse A Davidson; Tracy Urban; Suhong Tong; Mark Twite; Alan Woodruff; Paul E Wischmeyer; Jelena Klawitter Journal: PLoS One Date: 2016-07-06 Impact factor: 3.240