Monitoring Biomarkers After Pediatric Heart Surgery: A New Paradigm on the Horizon

Ağırbaşlı, Mehmet; Ündar, Akif

doi:10.1111/j.1525-1594.2012.01573.x

Cited by 9 publications

(8 citation statements)

References 41 publications

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“…Cerebral injury is a major cause of morbidity following cardiopulmonary bypass (CPB) in children (1). The molecular events underlying brain damage following CPB are complex (2), and the precise inflammatory mechanisms leading to neurological injury following CPB in children remain to be fully elucidated. Monitoring of inflammatory biomarkers may help us to understand the pathophysiology of cerebral damage after CPB in children.…”

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confidence: 99%

Apolipoprotein E Levels in Pediatric Patients Undergoing Cardiopulmonary Bypass

et al. 2015

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Apolipoprotein E (apoE) may play a critical role in modulating the response to neurological injury after cardiopulmonary bypass (CPB) in children. Plasma samples were collected from 38 pediatric patients. Half of the patients received nonpulsatile flow and the other half underwent pulsatile flow during CPB. Plasma samples were collected at three time points: at baseline prior to incision (T1), 1 h after CPB (T2), and 24 h after CPB (T3). The study included 38 pediatric patients undergoing heart surgery (mean age 2.5 ± 2.1 years). Baseline apoE levels were low (<30 μg/mL) in 21 patients (55%). ApoE levels were significantly decreased at 1 h after CPB compared with baseline (22 ± 14 vs. 34 ± 18 μg/mL, P = 0.001). At 24 h after CPB, apoE levels were significantly increased compared with baseline (47 ± 25 vs. 34 ± 18 μg/mL, P = 0.002). Pulsatile mode was associated with lower apoE levels at 24 h after CPB compared with nonpulsatile mode (38 ± 14 vs. 57 ± 29 μg/mL, P = 0.018). ApoE levels correlated negatively with pump time (r = -0.525, P = 0.021) and cross-clamp time (r = -0.464, P = 0.045) at 24 h following CPB for the nonpulsatile group but not for the pulsatile group. In this cohort of young children with congenital heart disease, baseline apoE levels were low in the majority of patients prior to surgery. ApoE levels decreased further at 1 h after CPB, and then significantly increased by 24 h. The mode of perfusion and the duration of pump time and clamp time influence the apoE levels after CPB. An improved understanding of these mechanisms may translate into the development of new techniques to improve the clinical outcomes after pediatric CPB.

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confidence: 99%

Apolipoprotein E Levels in Pediatric Patients Undergoing Cardiopulmonary Bypass

et al. 2015

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“…Further, we hypothesize that pulsatile perfusion will be less likely to be associated with an imbalance in the ratio of the components of the fibrinolytic system. Elucidating the response of these biomarkers to cardiopulmonary bypass may improve our understanding of the pathophysiologic mechanisms contributing to perioperative morbidity in children undergoing surgery for congenital heart disease .…”

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Comparative Effects of Pulsatile and Nonpulsatile Flow on Plasma Fibrinolytic Balance in Pediatric Patients Undergoing Cardiopulmonary Bypass

et al. 2013

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In the brain, the components of the fibrinolytic system, tissue plasminogen activator (tPA) and its endogenous inhibitor plasminogen activator inhibitor-1 (PAI-1), regulate various neurophysiological and pathological responses. Fibrinolytic balance depends on PAI-1 and tPA concentrations. The objective of this study is to compare the effects of pulsatile and nonpulsatile perfusion on fibrinolytic balance in children undergoing pediatric cardiopulmonary bypass (CPB). Plasma PAI-1 antigen and tPA antigen were measured in 40 children (n = 20 pulsatile and n = 20 nonpulsatile group). Plasma samples (1.5 mL) were collected (i) prior to incision, (ii) 1 h after CPB, and (iii) 24 h after CPB. PAI-1 and tPA levels were measured at each time point. PAI-1 and tPA levels were significantly increased at 1 h after CPB, followed by a decrease at 24 h. Nonpulsatile but not pulsatile CPB lowered PAI-1 : tPA ratio significantly at 24 h (median PAI-1 : tPA ratio 4.63 ± 0.83:1.98 ± 0.48, P = 0.03, for the nonpulsatile group and 4.50 ± 0.92:3.56 ± 1.28, P = 0.2, for the pulsatile group). These results suggest that pulsatile flow maintains endogenous fibrinolytic balance after pediatric cardiopulmonary bypass. Further studies are needed to define the clinical significance of these differences.

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“…Several miRNAs have been previously shown to correlate with troponin in various clinical settings (14,20,23), and we provide an additional setting in which such a correlation is observed. We note, however, that cTn suffers from some limitations as a biomarker for myocardial damage: it is elevated in states of impaired renal function and in neonates (24), and its typical release pattern is rather slow (13,17). Further studies are needed to determine whether miRNA-208a, -208b, and -499 demonstrate an advantage over troponin as biomarkers for myocardial injury in clinical use.…”

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confidence: 90%

“…Calculation of the shortening fraction (SF) of the left ventricle in transthoracic echocardiography before and 24 hours post operation was performed by an independent pediatric cardiologist: SF reduction % = (pre-operative SF) -(postoperative SF) × 100/(pre-operative SF). Risk adjustment for congenital heart surgery-1 and Aristotle scores were used (16,17).…”

Section: Clinical Datamentioning

confidence: 99%