Clinical benefit of cardiac ischemic postconditioning in corrections of tetralogy of Fallot

Abstract

The postoperative course of cyanotic patients is generally more complicated than in acyanotic patients. The ischemic postconditioning provides protection from myocardial injury. We conducted a randomized trial to evaluate the clinical benefits of postconditioning in patients undergoing repair of tetralogy of Fallot. Ninety-nine patients with tetralogy of Fallot were randomly assigned to ischemic postconditioning group (n=48) or control group (n=51). The 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. There was one death in postconditioned group and two in control. Major non-fatal morbidity was reduced in postconditioned patients (12.5%, 6/48) compared with control (33.3%, 17/51, P=0.016). The troponin I was significantly lower (P=0.026) with reduced inotrope score (P=0.001) and lactate release (P=0.019) in postconditioned patients. The ventilation time was significantly reduced in postconditioned patients compared with control (14±15 h vs. 25±28 h, P=0.024). There was a significant decrease in the ICU stay in the postconditioned patients (P=0.048). The study suggests that ischemic postconditioning may provide clinical benefits with respect to the morbidity, ventilation time, ICU stay, requirement of inotrope in patients undergoing repair for tetralogy of Fallot. © 2009 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.