Abstract 11473: Renal and Cardiac Effects of Remote Ischemic Preconditioning in Children Undergoing Cardiopulmonary Bypass Surgery

HomeCirculationAbstract 11473: Renal and Cardiac Effects of Remote Ischemic Preconditioning in Children Undergoing Cardiopulmonary Bypass Surgery Free AccessAbstractAboutSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractCongenital Heart Disease and Pediatric CardiologySession Title: Congenital Cardiac SurgeryAbstract 11473: Renal and Cardiac Effects of Remote Ischemic Preconditioning in Children Undergoing Cardiopulmonary Bypass Surgery Yuk M Law, Christine Hsu, Ronit Katz, sangeeta hingorani, David MCMULLAN, Michael Richards, Howard Jeffries, Rong Tian and Jonathan Himmelfarb Yuk M LawYuk M Law SEATTLE CHILDRENS HOSPITAL, Seattle, WA Search for more papers by this author , Christine HsuChristine Hsu Kaiser Permanente, Seattle, WA Search for more papers by this author , Ronit KatzRonit Katz Univ of Washington, Seattle, WA Search for more papers by this author , sangeeta hingoranisangeeta hingorani Seattle Children's Hosp, Seattle, WA Search for more papers by this author , David MCMULLANDavid MCMULLAN CHILDRENS HOSP REG MEDICAL CTR, Seattle, WA Search for more papers by this author , Michael RichardsMichael Richards Seattle Children's Hosp Search for more papers by this author , Howard JeffriesHoward Jeffries SEATTLE CHILDRENS HOSPITAL, Seattle, WA Search for more papers by this author , Rong TianRong Tian UNIVERSITY WASHINGTON, Seattle, WA Search for more papers by this author and Jonathan HimmelfarbJonathan Himmelfarb Univ of Washington, Seattle, WA Search for more papers by this author Originally published8 Nov 2021https://doi.org/10.1161/circ.144.suppl_1.11473Circulation. 2021;144:A11473AbstractIntroduction: Children undergoing cardiac surgery are at risk for AKI and cardiac dysfunction affecting outcome. Improved surgical techniques and post-operative care allow better outcomes in complex repairs and at-risk patients. Opportunity exists in further protecting multiple end organ function with remote ischemic preconditioning (RIPC) given promising but mixed data in adults and children.Hypothesis: A non-invasive technique of inducing reversible lower extremity ischemia with inflation of pressure cuff lessens renal and myocardial injury.Methods: A single center randomized, placebo controlled, double blinded trial of RIPC in children undergoing cardiac surgery of RACHS-1 category 2 or greater. RIPC was performed in the operating room after anesthesia and before sternotomy. Pre-specified end points are change in creatinine, eGFR, development of AKI, B-type natriuretic peptide and Troponin I at 6, 12, 24, 48, 72 hours post separation from bypass. Secondary end points included select clinical outcomes.Results: There were 45 in the RIPC and 39 patients in the control group: age was 3.5 and 3.8 years, respectively; 57 patients below 1 year of age; 35 patients below 1 month of age. There was no difference between groups in creatinine, cystatin C, eGFR at each time points. There was a trend for a larger rate of decrease, especially for cystatin C (p=0.042) in the RIPC group but the magnitude was small. AKI was observed in 21 (54%) of control and 16 (36%) of RIPC group (p=0.094). Adjusting for baseline creatinine, the odds ratio for AKI in in RIPC compared to control group was 0.31 (p=0.037). Adjusted for clinical characteristics, the odds ratio was 0.34 (p=0.056). Peak troponin occurred at 6 hrs. Compared to control, the RIPC group had a lower troponin at 6 hrs (p=0.140). However, no difference in other analyses of troponin and B-type natriuretic peptides between the groups. Length of stay, all-cause mortality, systolic function by echocardiography and composite clinical end points of advanced renal and heart failure were not different between groups.Conclusions: There is suggestion of RIPC delivering renal protection in an at-risk pediatric population. Additional larger, higher risk population studies will be required to fully determine its efficacy.FootnotesAuthor Disclosures: For author disclosure information, please visit the AHA Scientific Sessions 2021 Online Program Planner and search for the abstract title. eLetters(0) eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate. Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page. Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails November 16, 2021Vol 144, Issue Suppl_1 Advertisement Article Information Metrics © 2021 by American Heart Association, Inc.https://doi.org/10.1161/circ.144.suppl_1.11473 Originally publishedNovember 8, 2021 KeywordsCongenital heart surgery, pediatricCardioprotectionAcute kidney injuryCongenital heart diseasePediatric cardiology Advertisement