A comparison of cardiac post-conditioning and remote pre-conditioning in paediatric cardiac surgery

Abstract

Our study demonstrates that ischaemic post-conditioning and remote ischaemic pre-conditioning provide comparable myocardial benefit in children undergoing cold blood cardioplegic arrest.

Experimental cardiovascular and lung research Remote ischemic preconditioning versus standard myocardial protection in cardiac surgery: ten years of clinical trials. A systematic review and meta-analysis

“…Studies concerning isolated valvular surgery did not confirm the protective result of rIPC; however, heterogeneity (I 2 = 94%) was essentially influencing the outcome effect under the random [28][29][30]. Relevant outcomes associated with rIPC were found in patients undergoing pediatric cardiac surgery without heterogeneity (I 2 = 0%) (SMD -1.19; 95% CI: -1.56 to -0.82; p = 0.00001) [30][31][32]. When the rIPC protocol was performed in the anatomic region of the lower extremities, the result was significant (SMD -1.31; 95% CI: 2.14 to 0.48; p = 0.002) with peaked heterogeneity (I 2 = 88%).…”

“…Finally, fifteen papers were found to present the best available evidence. These studies pertained to: adult coronary bypass grafting surgery with or without AVR [9,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], adult valvular surgery [28][29][30], and pediatric cardiac surgery [31][32][33]. All the available papers were designed as prospective randomized controlled trials.…”

“…The majority of patients were operated on due to coronary artery disease (335 in the rIPC group and 340 in the control group) [9,[20][21][22][23][24][25][26][27]. The analysis of rIPC in pediatric patients undergoing cardiac surgery included 67 patients in the rIPC study groups and 70 in the control groups [31][32][33], whereas 89 and 90 patients were submitted to isolated valvular surgery with or without rIPC, respectively [28][29][30]. All studies were proof-of-concept trials with small sample sizes, and only three included more than 100 patients [20][21][22].…”

“…Secondly, this meta-analysis gathered its evidence from proofof-concept trials, which are, by definition, limited in terms of the number of participants. Funnel plot analysis was employed to find evidence of asymmetry, and four studies were indeed found to lie outside the 95% confidence interval, with one additional study located on its border [20,21,24,28,31] (Fig. 3).…”

“…In order to correct for the high heterogeneity in the whole population, we restricted the analysis to studies lying inside the 95% CI on the funnel plot, excluding five studies [20,21,24,28,31]. This correction changed the heterogeneity from 83% to 0% and the effect was still highly significant (SMD -0.69; 95% CI: -0.86 to -0.51; p = 0.00001).…”