Cardiac protective effects of remote ischaemic preconditioning in children undergoing tetralogy of fallot repair surgery: a randomized controlled trial.
Cardiac protective effects of remote ischaemic preconditioning in children undergoing tetralogy of fallot repair surgery: a randomized controlled trial.
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远程缺血预处理对接受法洛四联症修复手术的儿童的心脏保护作用：随机对照试验
DOI：
10.1093/eurheartj/ehx030
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发表时间：
2018-03-21
影响因子：
39.3
通讯作者：
Xia Z
中科院分区：
文献类型：
--
作者：
Wu Q;Wang T;Chen S;Zhou Q;Li H;Hu N;Feng Y;Dong N;Yao S;Xia Z
远程缺血预处理（RIPC）通过诱导远端组织短暂缺血来保护接受心内直视手术的儿童心脏免受心肌缺血再灌注损伤（IRI），尽管其在患有合并症的成人中的有效性存在争议。RIPC对接受心内直视手术的法洛四联症（ToF）患儿（一种严重紫绀型先天性心脏病）心肌IRI的有效性和机制尚不清楚。我们假设RIPC可以在接受ToF修复手术的儿童中提供心脏保护。总体而言，112例接受采用心肺转流（CPB）的根治性心脏直视手术的ToF儿童被随机分配至RIPC组（n = 55）或对照组（n = 57）。RIPC方案包括3个周期的5分钟下肢闭塞和5分钟再灌注使用袖带充气机。分别于术前和术后测定血清炎性细胞因子和心肌损伤标志物。在手术期间收集右心室流出道（RVOT）组织，以评估缺氧诱导因子（Hif）-1α和其他信号蛋白。电镜观察心肌线粒体损伤。初步结果显示，对照组在重症监护室（ICU）的住院时间长于RIPC组（分别为52.30 ± 13.43 h vs. 47.55 ± 10.34 h，P = 0.039）。与RIPC组相比，对照组患者需要更长的术后通气时间（分别为35.02 ± 6.56 h和31.96 ± 6.60 h，P = 0.016）。与对照组相比，RIPC组术后12和18 h的血清肌钙蛋白-T、24 h的CK-MB以及6 h的血清h-FABP水平均显著降低，这与心脏Hif-1α、p-Akt、p-STAT 3、p-STAT 5和p-eNOS蛋白表达显著升高以及线粒体空泡化较少相一致。在接受心内直视手术的ToF儿童中，RIPC减轻了心肌IRI并改善了短期预后。
Remote ischaemic preconditioning (RIPC) by inducing brief ischaemia in distant tissues protects the heart against myocardial ischaemia-reperfusion injury (IRI) in children undergoing open-heart surgery, although its effectiveness in adults with comorbidities is controversial. The effectiveness and mechanism of RIPC with respect to myocardial IRI in children with tetralogy of Fallot (ToF), a severe cyanotic congenital cardiac disease, undergoing open heart surgery are unclear. We hypothesized that RIPC can confer cardioprotection in children undergoing ToF repair surgery. Overall, 112 ToF children undergoing radical open cardiac surgery using cardiopulmonary bypass (CPB) were randomized to either a RIPC group (n = 55) or a control group (n = 57). The RIPC protocol consisted of three cycles of 5-min lower limb occlusion and 5-min reperfusion using a cuff-inflator. Serum inflammatory cytokines and cardiac injury markers were measured before surgery and after CPB. Right ventricle outflow tract (RVOT) tissues were collected during the surgery to assess hypoxia-inducible factor (Hif)-1α and other signalling proteins. Cardiac mitochondrial injury was assessed by electron microscopy. The primary results showed that the length of stay in the intensive care unit (ICU) was longer in the control group than in the RIPC group (52.30 ± 13.43 h vs. 47.55 ± 10.34 h, respectively, P = 0.039). Patients in the control group needed longer post-operative ventilation time compared to the RIPC group (35.02 ± 6.56 h vs. 31.96 ± 6.60 h, respectively, P = 0.016). The levels of post-operative serum troponin-T at 12 and 18 h, CK-MB at 24 h, as well as the serum h-FABP levels at 6 h, after CPB were significantly lower, which was coincident with significantly higher protein expression of cardiac Hif-1α, p-Akt, p-STAT3, p-STAT5, and p-eNOS and less vacuolization of mitochondria in the RIPC group compared to the control group. In ToF children undergoing open heart surgery, RIPC attenuates myocardial IRI and improves the short-term prognosis.
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影响因子：
2.9
作者：
Almashrafi A;Alsabti H;Mukaddirov M;Balan B;Aylin P
通讯作者：
Aylin P
影响因子：
3.7
作者：
Hepponstall M;Ignjatovic V;Binos S;Attard C;Karlaftis V;d'Udekem Y;Monagle P;Konstantinov IE
通讯作者：
Konstantinov IE
影响因子：
4.6
作者：
Kleinbongard, Petra;Schulz, Rainer;Heusch, Gerd
通讯作者：
Heusch, Gerd
影响因子：
37.8
作者：
Kharbanda, RK;Peters, M;MacAllister, R
通讯作者：
MacAllister, R
DOI：
10.1016/j.jtcvs.2013.01.005
发表时间：
2014-01-01
影响因子：
6
作者：
Kottenberg, Eva;Musiolik, Judith;Heusch, Gerd
通讯作者：
Heusch, Gerd