[Cardiopulmonary protection of ischemic postconditioning in cardiac surgery in children with tetralogy of Fallot].
OBJECTIVE
Ischemic postconditioning effectively minimizes the ischemic/reperfusion injury, and the large series of case reports on its protective effects in cardiac surgery are limited. A randomized trial was conducted to investigate the effect of ischemic postconditioning on cardiopulmonary protection in children undergoing cardiac surgery for tetralogy of Fallot.


METHODS
One hundred and five-children with tetralogy of Fallot undergoing surgery were randomly assigned to control (n=58) and ischemic postconditioning groups (n=47). Ischemic postconditioning was performed by intermittent aortic clamping after reperfusion. After surgery, the duration of intensive care unit (ICU) stay, capacity of blood transfusion, hemodynamics, inotropic scores, respiratory function, and release of blood lactate were assayed.


RESULTS
There was a significant decrease in the ICU stay in the postconditioned group compared with the control group (37+/-21 hrs vs 54+/-26 hrs; P<0.05 ). The capacity of blood transfusion (308+/-230 mL vs 526+/-515 mL; P<0.05) and the inotropic scores (5.9+/-5.0 vs 10.3+/-7.7; P<0.05) in the postconditioned group were significantly reduced compared with those in the control group. Blood lactate contents in the postconditioned group was significantly lower that those in the control group 1, 3, 6, 9, 12 and 20 hrs after surgery. The postconditioned group showed more improved hemodynamics and respiratory function than the control group.


CONCLUSIONS
Ischemic postconditioning may provide clinical benefits with respects to myocardial and pulmonary protections in children undergoing repair for tetralogy of Fallot.
Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha 410008, China.
Ri
R
Chen
Wan-Jun
WJ
Luo
Hai-He
HH
Jiang
Long
L
Long
Ri-Mao
RM
Huang
Fan-Yan
FY
Luo
D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control; D012119:Respiration; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000601:surgery*
D019344:Lactic Acid