Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-10T07:48:26.837Z Has data issue: false hasContentIssue false
  • English
  • Français

Does cardioplegia leave room for postconditioning in paediatric cardiac surgery?*

Published online by Cambridge University Press:  01 June 2008

Wanjun Luo ,
Bei Li ,
Guoqiang Lin ,
Ri Chen  and
Rimao Huang
Wanjun Luo*
Affiliation:
Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, Peoples Republic of China
Bei Li
Affiliation:
Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, Peoples Republic of China
Guoqiang Lin
Affiliation:
Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, Peoples Republic of China
Ri Chen
Affiliation:
Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, Peoples Republic of China
Rimao Huang
Affiliation:
Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, Peoples Republic of China
*
Department of Cardiothoracic Surgery, Xiang Ya Hospital, Changsha, Hunan, 410008, P.R.China. Tel: +86-731-4310800; Fax: +86-731-4327247; E-mail: luowanjun@yahoo.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Postconditioning by brief episodes of ischaemia performed just at the time of reperfusion have been shown to reduce the size of infarcts in animal models, and in the clinical setting of percutaneous cardiac intervention. The clinical applicability of postconditioning in cardiac surgery remains to be determined. We investigated the effect of postconditioning on myocardial protection in children undergoing cardiac surgery.

Methods

We randomly assigned 40 patients scheduled for surgical correction of congenitally malformed hearts under cold blood cardioplegic arrest to postconditioning or control treatment. Postconditioning was performed by two cycles of 30 seconds ischaemia and 30 seconds reperfusion using aortic reclamping, and declamping started 30 seconds after cardioplegic arrest. We assayed creatine kinase-MB, troponin I, transcardiac release of lactate and neutrophil counts.

Results

The types of procedure, age, bypass and aortic cross-clamping times were similar in both groups. The postoperative peaks of creatine kinase-MB and troponin I were lower after aortic de-clamping in the postconditioned patients compared with their controls (128 ± 48 units per liter as opposed to 199 ± 79 units per liter, p = 0.016, and 0.34 ± 0.21 nanograms per milliliter as opposed to 0.61 ± 0.53 nanograms per milliliter, p = 0.05), with reduced inotropic scores in those submitted to postconditioning compared with their controls (4.8 ± 3.1 versus 2.3 ± 1.5, p = 0.036). Transcardiac release of lactate was reduced in the postconditioned patients compared with their controls (0.10 ± 0.27 as opposed to 0.37 ± 0.43 millimols per liter, p = 0.048). No differences between groups were found for transcardiac neutrophil count during reperfusion (10.8 ± 6.3% for postconditioning versus 14.0 ± 8.7% for controls, p = 0.48).

Conclusions

Our study demonstrates that postconditioning may protect the myocardium of children undergoing cold blood cardioplegic arrest. These data support the need for a larger clinical trial of postconditiong in children undergoing cardiac surgery.

Keywords

Myocardial protectioncongenital heart diseaseischaemiareperfusion
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 3 , June 2008 , pp. 282 - 287
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

The presentation on which this work is based was given at the Inaugural Meeting of the World Society for Pediatric and Congenital Heart Surgery, held in Washington, District of Columbia, May 3 and 4, 2007.

References

1.Lacour-Gayet, F, Clarke, D, Jacobs, J, et al. Aristotle Committee. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004; 25: 911–924.CrossRefGoogle Scholar
2.Allen, BS. Paediatrics myocardial protection: Where do we stand? J Thorac Cardiovasc Surg 2004; 128: 11–13.CrossRefGoogle ScholarPubMed
3.Zhao, ZQ, Corvera, JS, Alkos, ME, et al. Inhibition of myocardial injury by ischemic postconditioning during reperfusion:comparison with ischemic preconditioning. Am J Physiol Heart Circ Physiol 2003; 285: H579–H588.CrossRefGoogle ScholarPubMed
4.Zhao, ZQ, Vinten-Johansen, J. Postconditioning: reduction of reperfusion-induced injury. Cardiovasc Res 2006; 70: 200–211.CrossRefGoogle ScholarPubMed
5.Staat, P, Rioufol, G, Piot, C, et al. Postconditioning the human heart. Circulation 2005; 112: 2143–2148.CrossRefGoogle ScholarPubMed
6.Laskey, WK. Brief repetitive balloon occlusions enhance reperfusion during percutaneous coronary intervention for acute myocardial infarction: a pilot study. Catheter Cardiovasc Interv 2005; 65: 361–367.CrossRefGoogle ScholarPubMed
7.Mildh, LH, Pettilä, V, Sairanen, HI, Rautiainen, PH. Cardiac troponin T levels for risk stratification in paediatrics open heart surgery. Ann Thorac Surg 2006; 82: 1643–1649.CrossRefGoogle ScholarPubMed
8.Imura, H, Caputo, M, Parry, A, Pawade, A, Angelini, GD, Suleiman, MS. Age-dependent and hypoxia-related differences in myocardial protection during paediatrics open heart surgery. Circulation 2001; 103: 1551–1556.CrossRefGoogle ScholarPubMed
9.Tsang, A, Hausenloy, DJ, Mocanu, MM, Yellon, DM. Postconditioning: a form of “modified reperfusion” protects the myocardium by activating the phosphatidylinositol 3-kinase-Akt pathway. Circ Res 2004; 95: 230–232.CrossRefGoogle ScholarPubMed
10.Galagudza, M, Kurapeev, D, Minasiana, S, Valen, G, Vaage, J. Ischemic postconditioning: brief ischaemia during reperfusion converts persistent ventricular fibrillation into regular rhythm. Eur J Cardiothorac Surg 2004; 25: 1006–1010.CrossRefGoogle ScholarPubMed
11.Serviddio, G, Di Venosa, N, Federici, A, et al. Brief hypoxia before normoxic reperfusion (postconditioning) protects the heart against ischemia-reperfusion injury by preventing mitochondria peroxyde production and glutathione depletion. FASEB J 2005; 19: 354–361.CrossRefGoogle ScholarPubMed
12.Kin, H, Zhao, ZQ, Sun, HY, Vinten-Johansen, J et al. Postconditioning attenuates myocardial ischemia-reperfusion injury by inhibiting events in the early minutes of reperfusion. Cardiovasc Res 2004; 62: 74–85.CrossRefGoogle ScholarPubMed
13.Yang, XM, Proctor, JB, Cui, Lin, Krieg, T, Downey, JM, Cohen, MV. Multiple, brief coronary occlusions during early reperfusion protect rabbit hearts by targeting cell signaling pathways. J Am Coll Cardiol 2004; 44: 1103–1110.CrossRefGoogle ScholarPubMed
14.Argaud, L, Gateau-Roesch, O, Raisky, O, Loufouat, J, Robert, D, Ovize, M. Post-conditioning inhibits mitochondrial permeability transition. Circulation 2005; 111: 194–197.CrossRefGoogle Scholar
15.Hausenloy, DJ, Yellon, DM. Survival kinases in ischemic preconditioning and postconditioning. Cardiovasc Res 2006; 70: 240–253.CrossRefGoogle ScholarPubMed
16.Ramzy, D, Rao, V, Weisel, RD. Clinical applicability of preconditioning and postconditioning: The cardiothoracic surgeons’ view. Cardiovasc Res 2006; 70: 174–180.CrossRefGoogle Scholar