title: Effect of remote ischaemic preconditioning on ischaemic-reperfusion injury in pulmonary hypertensive infants receiving ventricular septal defect repair.
abstract: BACKGROUND
  Remote ischaemic preconditioning (RIPC) can reduce ischaemic-reperfusion injury in distant organs. The myocardial and pulmonary protective effect of RIPC in infants with pulmonary hypertension remains unclear. We conducted a randomized controlled trial to evaluate the effect of RIPC in infants receiving ventricular septal defect (VSD) repair.
  
  
  METHODS
  We studied 55 infants with pulmonary hypertension undergoing VSD repair (RIPC group, n=27; control group, n=28). RIPC consisted of four 5 min cycles of lower limb ischaemia and reperfusion. Serum troponin I (TnI) concentrations were measured after induction of anaesthesia and at 1, 6, 12, and 24 h after surgery. Other clinical data such as inotropic score, lung compliance, alveolar-arterial oxygen gradient, oxygen index, mechanical ventilation time, and length of intensive care unit stay were also recorded at each interval.
  
  
  RESULTS
  No differences in patient or surgical characteristics were observed between the two groups. There were no significant differences in postoperative TnI levels according to time (P=0.35) or the total amount of TnI release, expressed as the area under the curve over the 24 h after surgery [RIPC vs control: 207.6 (134.0) vs 274.6 (263.7) h ng ml(-1), P=0.24]. All other clinical data were also comparable.
  
  
  CONCLUSIONS
  RIPC does not reduce the postoperative TnI release after VSD repair in infants with pulmonary hypertension. Additionally, it is difficult to find significant clinical benefits of RIPC in this population. The effect of RIPC varies according to clinical situation and patient condition.
  
  
  BACKGROUND
  ClinicalTrials.gov, NCT01313832.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Lee
authors.forename: Y-H
authors.initials: YH
authors.lastname: Park
authors.forename: H-J
authors.initials: HJ
authors.lastname: Byon
authors.forename: H-S
authors.initials: HS
authors.lastname: Kim
authors.forename: C-S
authors.initials: CS
authors.lastname: Kim
authors.forename: J-T
authors.initials: JT
authors.lastname: Kim
mesh_terms: D000768:Anesthesia, General / Q000379:methods; D015415:Biomarkers / Q000097:blood; D004311:Double-Blind Method; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000601:surgery; D007223:Infant; D007430:Intraoperative Care / Q000379:methods; D019194:Ischemic Preconditioning / Q000379:methods*; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D015427:Reperfusion Injury / Q000517:prevention & control*; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I