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Objective: The study objective was to determine whether adequately delivered bilateral remote ischemic preconditioning is cardioprotective in young children undergoing surgery for 2 common congenital heart defects with or without cyanosis. Methods: We performed a prospective, double-blind, randomized controlled trial at 2 centers in the United Kingdom. Children aged 3 to 36 months undergoing tetralogy of Fallot repair or ventricular septal defect closure were randomized 1:1 to receive bilateral preconditioning or sham intervention. Participants were followed up until hospital discharge or 30 days. The primary outcome was area under the curve for high-sensitivity troponin-T in the first 24 hours after surgery, analyzed by intention-to-treat. Right atrial biopsies were obtained in selected participants. Results: Between October 2016 and December 2020, 120 eligible children were randomized to receive bilateral preconditioning (n = 60) or sham intervention (n = 60). The primary outcome, area under the curve for high-sensitivity troponin-T, was higher in the preconditioning group (mean: 70.0 ± 50.9 μg/L/h, n = 56) than in controls (mean: 55.6 ± 30.1 μg/L/h, n = 58) (mean difference, 13.2 μg/L/h; 95% CI, 0.5-25.8; P = .04). Subgroup analyses did not show a differential treatment effect by oxygen saturations (pinteraction = .25), but there was evidence of a differential effect by underlying defect (pinteraction = .04). Secondary outcomes and myocardial metabolism, quantified in atrial biopsies, were not different between randomized groups. Conclusions: Bilateral remote ischemic preconditioning does not attenuate myocardial injury in children undergoing surgical repair for congenital heart defects, and there was evidence of potential harm in unstented tetralogy of Fallot. The routine use of remote ischemic preconditioning cannot be recommended for myocardial protection during pediatric cardiac surgery.

Background: The incidence of mechanical circulatory support (MCS) for early graft dysfunction (EGD) following heart transplantation varies from 2.3% to 28.2%. Low pulmonary pulsatility index (PAPI) is associated with higher mortality in advanced heart failure and cardiogenic shock. We hypothesized that a lower pulmonary pulsatility index following heart transplantation is associated with MCS use for EGD Methods: Two-center study of consecutive heart transplantation from May 2018 to December 2022. Hemodynamic parameters and inotropic/vasoconstrictor data were investigated on admission to the intensive care unit (T0) and at 6 hours later (T6). Results: Of the 173 patients included in this study, 24 had MCS for EGD. PAPI in the group that required MCS was lower at T0 (1.21 (0.84) vs 1.67 (1.23), p = 0.001) and T6 (0.77 (0.52) vs 1.44 (0.82), p =