Objective: The postoperative course in children with cyanotic congenital heart defect is generally more complicated than that of acyanotic patients. The ischemic postconditioning provide protection from myocardial injury. We conducted a randomized trial to evaluate the effect of postconditioning in children undergoing repair of tetralogy of Fallot.
Methods: Sixty and six children with tetralogy of Fallot were randomly assigned to ischemic postconditioning group (n=34, aged 2.4±1.0 yrs) or control group (n=32, aged 2.4±1.2 yrs). The ischemic postconditioning was performed by intermittent aortic clamping after reperfusion. The morbidity, mortality, ventilation time, length of ICU stay, inotropic score, release of troponin I and lactate were assayed.
Results: The two groups were comparable. There were one death in postconditioned group and one in control. The cardiopulmonary complications was reduced in postconditioned patients (8.8.%, 3/34) compared with control (37.5%, 12/32, P<0.05).The troponin I was significantly lower (P<0.05) with reduced inotrope score (5.5±3.3 vs 10.1±4.9 , P<0.01) and lactate release (P<0.05) in postconditioned patients. The ventilation time was significantly reduced in postconditioned patients compared with control (14±13 h vs 31±33 h , p<0.05). There was a significant decreased in the ICU stay in the postconditioned patients (42±25h vs 71±49h, P<0.05).
Conclusions: The study suggests that ischemic postconditioning may provide clinical benefits with respect to the cardiopulmonary morbidity, ventilation time, ICU stay, requirement of inotrope in children undergoing repair for tetralogy of Fallot.