Cytokine Response in Children Undergoing Surgery for Congenital Heart Disease

Abstract

Pediatric cardiac surgery with cardiopulmonary bypass (CPB) induces a complex inflammatory response that may cause multiorgan dysfunction. The objective of this study was to measure postoperative cytokine production and correlate the magnitude of this response with intraoperative variables and postoperative outcomes. Serum samples from 20 children (median age, 15 months) undergoing cardiac surgery with CPB were obtained preoperatively and on postoperative days (POD) 1-3. Serum levels of interleukin (IL)-6, IL-8, and IL-10 increased significantly on POD 1 (p < 0.01) vs pre-op values to 271 +/- 68, 44 +/- 9, 7.5 +/- 0.8 pg/ml, respectively, whereas serum IL-1beta, IL-12, and tumor neurosis factor -alpha were not significantly changed. The serum IL-6 and IL-8 levels correlated positively (p < 0.01) with the degree of postoperative medical intervention as measured by the Therapeutic Interventional Scoring System and indicated a greater need for inotropic support (p = 0.057). A negative correlation (p < 0.01) between IL-6, IL-8, and mixed venous oxygen saturation suggested compromised cardiopulmonary function. Patients with single ventricle anatomy had the highest levels of IL-6 and IL-8 (629 +/- 131 and 70 +/- 17 pg/ml, respectively), with a mean CPB time of 106 +/- 23 minutes. Thus, the proinflammatory response after surgery with CPB was associated with postoperative morbidity with increased need for medical intervention.

Macrophage Migration Inhibitory Factor in Pediatric Patients Undergoing Surgery for Congenital Heart Repair

“…This IL-8 response to CPB was similar to our previously published study in pediatric patients undergoing cardiopulmonary bypass surgery (18). There was significant within-patient positive correlation between plasma MIF and IL-8 levels (r = 0.57, P < 0.001), suggesting that CPB resulted in a significant induction of these inflammatory mediators with similar temporal resolution after surgery.…”

“…Surgical procedures including cardiopulmonary bypass and perioperative anesthesia followed standard practices (18). Aprotinin was administered to all patients as an initial loading dose (240 mg/m 2 ) after anesthesia induction, followed by infusion of 56 mg/m 2 /h and an equivalent dose in the bypass prime.…”

“…We have previously reported that pediatric cardiac surgery involving CPB induced proinflammatory cytokine production that correlated with postoperative morbidity and cardiopulmonary dysfunction (18) and caused an impairment of the hypothalamic-pituitarythyroid axis as measured by reduction in plasma thyroid hormone levels (19)(20)(21). The objectives of this study were to measure circulating levels of MIF before surgery and after cardiopulmonary bypass in children and to correlate these finding with intra-operative variables and postoperative outcomes.…”

Creation of Ventricular Septal Defects on the Beating Heart in a New Pig Model

“…Surgery is generally associated with side effects such as prolonged admission, scar formation, and discomfort [4] . Furthermore, surgery requires ECC which may be associated with various adverse effects such as impaired neurological development [9,10] or systemic inflammatory response syndrome [8] . Recently, interventional therapy for closure of mVSDs has shown promising results [12,14,15] .…”

“…Furthermore, surgery requires extracorporeal circulation (ECC), which may be associated with different adverse effects [8][9][10] . The alternative of interventional strategies are limited by poor vascular access, especially in small infants [11] .…”