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document
Effect of ischemic postconditioning in correction of tetralogy of Fallot . Inappropriate myocardial protection is considered one of the main causes of mortality and morbidity in the correction of tetralogy of Fallot ( TOF ) . Results of previous reports about the effects of ischemic postconditioning on myocardial protection in animals and humans are very encouraging . This randomized and controlled trial aimed to assess the effect of ischemic postconditioning on protection against myocardial ischemia reperfusion injury in TOF patients receiving cardioplegia . From January 2008 to June 2010 , 80 consecutive children undergoing correction of TOF were enrolled and randomly assigned to either a postconditioning group ( three cycles of 30 seconds of ischemia and 30 seconds of reperfusion using re-clamping and de-clamping starting 30 seconds after the initial de-clamping of the aorta , n = 41 ) or a control group ( n = 39 ) . Cardiac troponin I ( cTnI ) was assayed preoperatively , and then 4 hours , 8 hours , 12 hours , 20 hours , and 48 hours after persistent reperfusion . The pre- , intra- and postoperative relevant data of all selected patients were analyzed . As a result , ischemic postconditioning reduced postoperative peak release by 45 % for cTnI compared with the control group ( 0.43 ± 0.18 ng/mL versus 0.78 ± 0.15 ng/mL , P < 0.0001 ) . Ischemic postconditioned patients had a lower peak inotropic score during the first postoperative 24 hours ( 5.6 ± 2.2 µg/kg/minute versus 8.6 ± 3.6 µg/kg/minute , P < 0.0001 ) , extubation time ( 21.5 ± 7.3 hours versus 30.2 ± 12.4 hours , P = 0.0002 ) and length of ICU stay ( 43.4 ± 12.6 hours versus 56.3 ± 17.8 hours , P = 0.0003 ) , while they had a higher cardiac output on the first postoperative day ( 1.41 ± 0.26 L/minute versus 1.28 ± 0.25 L/minute , P = 0.0255 ) as compared to the control group . In conclusion , ischemic postconditioning may to some extent provide myocardial protection in children undergoing correction of tetralogy of Fallot .
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Intervention_Physical
enrolled and randomly assigned to either a postconditioning group
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Intervention_Surgical
three cycles of 30 seconds of ischemia and 30 seconds of reperfusion using re-clamping
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Intervention_Surgical
de-clamping starting 30 seconds after the initial de-clamping of the aorta , n = 41
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Intervention_Control
control group
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Outcome_Physical
ischemic postconditioning
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Outcome_Physical
myocardial protection
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Outcome_Physical
ischemic postconditioning
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Outcome_Physical
protection against myocardial ischemia
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Outcome_Physical
Cardiac troponin I
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Outcome_Other
postoperative peak release
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Participant_Condition
tetralogy of Fallot ( TOF ) .