Cardiac surgery with deep hypothermic circulatory arrest produces less systemic inflammatory response than low-flow cardiopulmonary bypass in newborns

Tassani, Peter; Barankay, A; Haas, Felix; Paek, Sung-Un; Heilmaier, Markus; Hess, John; Lange, Rüdiger; Richter, J

doi:10.1067/mtc.2002.121285

Cited by 43 publications

(20 citation statements)

References 28 publications

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“…This finding may be explained by a reduced incidence of systemic inflammatory response syndrome provoked by DHCA. 18,19 Other intraoperative factors, such as longer cardiopulmonary bypass time, 20 and extracardiac Fontan procedure, 21 have been associated with longer LOS in other studies, whereas fenestration and use of modified ultrafiltration have been found to be associated with shorter LOS. 15 In our study, none of these factors predicted LOS; and no pre–Fontan procedure catheterization variables or catheter-based interventions were associated with LOS.…”

Section: Discussionmentioning

confidence: 87%

Factors affecting Fontan length of stay: Results from the Single Ventricle Reconstruction trial

Ravishankar

Gerstenberger

Sleeper

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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Background In the Single Ventricle Reconstruction trial, infants with hypoplastic left heart syndrome (HLHS) who received a right-ventricle-to-pulmonary-artery shunt (RVPAS) versus a modified Blalock-Taussig shunt (MBTS) had lower early postoperative mortality, but more complications at 14 months. We explored the effect of shunt type and other patient, medical, and surgical factors on postoperative length of stay (LOS) after the Fontan operation. Methods Fontan postoperative course was ascertained from medical record review. Cox proportional hazards modeling was used to identify factors associated with LOS. Results Of 327 subjects who underwent Fontan, 323 were analyzed (1 death, 1 biventricular repair, 2 with missing data). Median age and weight at Fontan were 2.8 years (interquartile range [IQR]: 2.3, 3.4) and 12.7 kg (IQR: 11.4, 14.1), respectively. Fontan type was extracardiac in 55% and lateral tunnel in 45%; 87% were fenestrated. The RVPAS and MBTS subjects had similar LOS (median 11 days [IQR: 9, 18] vs 10 days [IQR: 9, 13]; P = .23). Independent risk factors for longer LOS were treatment center (P < .01), LOS at stage II (hazard ratio [HR] 1.02 for each additional day; P < .01), and pre-Fontan complications (HR 1.03 for each additional complication; P = .04). Use of deep hypothermic circulatory arrest at Fontan (HR 0.64; P = .02) was independently associated with shorter LOS. When center was excluded from the model, pre-Fontan complications and use of circulatory arrest were no longer significant; instead, older age at stage II (HR 1.08 for each additional month; P = .01) predicted longer LOS. In 254 subjects who had a pre-Fontan echocardiogram, at least moderate tricuspid regurgitation was independently associated with longer LOS, both with center (HR 1.72; P <.01) and without center in the model (HR 1.49; P = .02). Conclusions In this multicenter prospective cohort of subjects with HLHS, Norwood shunt type was not associated with Fontan LOS. Rather, global measures of earlier medical complexity indicate greater likelihood of longer LOS after the Fontan operation.

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Section: Discussionmentioning

confidence: 87%

Factors affecting Fontan length of stay: Results from the Single Ventricle Reconstruction trial

Ravishankar

Gerstenberger

Sleeper

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

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“…Additional variables that may have an important impact on the inflammatory response to CPB were not addressed in this study. For example, the use of deep hypothermic circulatory arrest rather than low-flow CPB appears to have favorable clinical effects on the postoperative inflammatory response in infants (27,28). Future prospective studies of steroid use during CPB should be designed to limit the potential confounding effects of such variables.…”

Section: Discussionmentioning

confidence: 95%

Steroid use before pediatric cardiac operations using cardiopulmonary bypass: An international survey of 36 centers*

Checchia

Bronicki

Costello

et al. 2005

Pediatric Critical Care Medicine

123

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Although nearly all centers surveyed administer steroids before cardiopulmonary bypass, the type, dosing, route, and timing of administration are highly variable. The inconsistencies in these data and the pediatric literature would support the undertaking of a large, multiple-center clinical trial to evaluate the risks and benefits of steroid administration before pediatric cardiopulmonary bypass.

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“…In this surgical setting, body temperatures of neonates are typically reduced to Յ18°C, a temperature that optimizes reductions in several pro-inflammatory markers (plasma IL-8, IL-6, anaphylatoxin C3a, and body weight gain; Ref. 35). In an experimental model of cardiopulmonary bypass in pigs, hypothermia was associated with reductions in lung tissue damage and plasma TNF-␣ and an increase in plasma IL-10 expression (15).…”

Section: Discussionmentioning

confidence: 99%

Hypothermia Induces Interleukin-10 and Attenuates Injury in the Lungs of Endotoxemic Rats

Sarcia¹,

Scumpia²,

Moldawer

et al. 2003

Shock

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We recently reported that hypothermia protects against intrapulmonary nitric oxide overproduction and nitric oxide-mediated lung injury in endotoxemic rats. Few studies have been performed to investigate whether hypothermia reduces inflammation by affecting favorable changes in chemokine and pro- and anti-inflammatory cytokine profiles. In this study, we tested the hypothesis that hypothermia decreases concentrations of growth-related oncogene/cytokine-induced neutrophil chemoattractant-1 (GRO/CINC-1), interleukin (IL)-1beta, IL-6, and myeloperoxidase and increases concentration of IL-10 in the lungs endotoxemic rats. Twelve rats were anesthetized and randomized to treatment with either hypothermia (T = 18-24 degrees C; n = 6) or normothermia (T = 36-38 degrees C, n = 6). Endotoxin (15 mg/kg of Escherichia coli lipopolysaccharide) was administered intravascularly and lung tissue was harvested 150 min later. Three additional rats were sham instrumented and maintained as normothermic but not given endotoxin. Hematoxylin & eosin staining was performed for qualitative inspection of tissues. Quantitative analyses of lung homogenates were performed using enzyme-linked immunosorbent assays for IL-1beta, IL-6, IL-10, and GRO/CINC-1. Myeloperoxidase concentrations were determined using a colorimetric assay. Hypothermia attenuated the induction of intrapulmonary IL-1beta (P < 0.05), IL-6 (P < 0.05), GRO/CINC-1 (P < 0.05), and myeloperoxidase (P < 0.05) caused by endotoxin. Inspection of the lungs revealed that hypothermia similarly attenuated histological signs of injury, such as interstitial edema and neutrophil accumulation. Hypothermia increased the intrapulmonary concentration of IL-10 more than 3-fold over that measured in the normothermia (endotoxin-exposed) group (P < 0.05). Hypothermia inhibits neutrophil recruitment in the lungs of endotoxemic rats in part by decreasing proinflammatory cytokine expression. Additionally, hypothermia induces intrapulmonary IL-10 expression. Further studies are needed to investigate whether IL-10 mediates the anti-inflammatory effects of hypothermia.

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Cardiac surgery with deep hypothermic circulatory arrest produces less systemic inflammatory response than low-flow cardiopulmonary bypass in newborns

Abstract: Deep hypothermic circulatory arrest produces less systemic inflammatory response than low-flow cardiopulmonary bypass. In addition, there is an indication of less fluid accumulation postoperatively.

Cited by 43 publications

References 28 publications

Factors affecting Fontan length of stay: Results from the Single Ventricle Reconstruction trial

Factors affecting Fontan length of stay: Results from the Single Ventricle Reconstruction trial

Steroid use before pediatric cardiac operations using cardiopulmonary bypass: An international survey of 36 centers*

Hypothermia Induces Interleukin-10 and Attenuates Injury in the Lungs of Endotoxemic Rats

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