title: Cardioprotective effect of remote ischemic postconditioning on children undergoing cardiac surgery: a randomized controlled trial.
abstract: BACKGROUND
  Remote ischemic postconditioning (RPostC) is a noninvasive intervention that has demonstrated cardioprotection and neuroprotection in animal studies.
  
  
  OBJECTIVE
  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).
  
  
  METHODS
  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 (200 mmHg) 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.
  
  
  RESULTS
  There were 35 children in the control group and 34 in the RPostC group. The mean age (3.64 ± 1.95 years vs. 3.45 ± 3.02 years, P = 0.80), weight (15.11 ± 6.91 kg vs. 13.40 ± 6.33 kg, P = 0.37), surgical time (144.82 ± 38.51 min vs. 129.92 ± 30.76 min, P = 0.15), and bypass time (78.01 ± 27.22 min vs. 72.52 ± 26.05 min, 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 ± 3.30 h vs. 60.57 ± 7.35 h, P = 0.006) and postoperative hospital stay (8.56 ± 1.50 days vs. 10.06 ± 2.41 days, 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.
  
  
  CONCLUSIONS
  RPostC significantly alleviates cardiac injury in children undergoing open-heart repair of CHD and may also reduce cerebral injury.
authors.affiliation: Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
authors.forename: Haixing
authors.initials: H
authors.lastname: Zhong
authors.forename: Zijun
authors.initials: Z
authors.lastname: Gao
authors.forename: Min
authors.initials: M
authors.lastname: Chen
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
authors.forename: Feng
authors.initials: F
authors.lastname: Wang
authors.forename: Liya
authors.initials: L
authors.lastname: Li
authors.forename: Hailong
authors.initials: H
authors.lastname: Dong
authors.forename: Lixin
authors.initials: L
authors.lastname: Liu
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wang
authors.forename: Lize
authors.initials: L
authors.lastname: Xiong
mesh_terms: D000758:Anesthesia; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002561:Cerebrovascular Disorders / Q000517:prevention & control; D002675:Child, Preschool; D052279:Creatine Kinase, MB Form / Q000097:blood; D016207:Cytokines / Q000097:blood; D003627:Data Interpretation, Statistical; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006331:Heart Diseases / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000517:prevention & control*; D057775:Ischemic Postconditioning / Q000379:methods*; D008297:Male; D010751:Phosphopyruvate Hydratase / Q000097:blood; D011183:Postoperative Complications / Q000517:prevention & control*; D064568:S100 Calcium Binding Protein beta Subunit / Q000097:blood; D018401:Sample Size; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D016207:Cytokines; D064568:S100 Calcium Binding Protein beta Subunit; C579160:S100B protein, human; D019210:Troponin I; D052279:Creatine Kinase, MB Form; D010751:Phosphopyruvate Hydratase
keywords: cardioprotection; ischemia/reperfusion; neuroprotection; pediatric; remote ischemic postconditioning