The systemic inflammatory response after cardiac surgery with cardiopulmonary bypass in children

Abstract

Paediatric cardiac surgery often requires cardiopulmonary bypass (CPB) during the surgical intervention. CPB is known to elicit a systemic inflammatory response with activation of the complement and coagulation systems, stimulation of cytokine production, cellular entrapment in organs, neutrophil activation with degranulation, platelet activation, and endothelial dysfunction. These changes are associated with a risk of postoperative organ dysfunction and increased morbidity and mortality in the postoperative period. Clinical studies have concentrated on measurement of inflammatory markers and mediators in peripheral blood, where the systemic inflammatory response in the paediatric cardiac patient seems to be different from the adult case. Looking at the organ level, experimental studies have the advantage of providing information contributing to a better understanding of the pathological events that may lead to the deteriorated organ function. This review focuses on the systemic inflammatory response after cardiac surgery with CPB in children and experimental CPB models.

The Neutrophil Lymphocyte Ratio as a Successful Extubation Predictor of Prolonged Intubation in Pediatric Heart Surgery

“…Immunological mechanisms and anatomical characteristics are relatively different in children from those in adults (11,12). Prolonged mechanical ventilation following pediatric cardiac surgery was consistently associated with longer CPB time in other studies (13,14).…”

Surgical Outcome of Total Anomalous Pulmonary Venous Return; Single Center Experience

“…Kardiyopulmoner baypas (KPB) kandaki pulmoner vazokonstriktör maddelerin artışına neden olmaktadır [8]. Erken postoperatif dönemde hem KPB'ın etkisi ile artmış pulmoner vazokonstriktör maddelerin varlığı ve hem de ventilasyon perfüzyon uyumsuzluğu sonucu oluşan alveolar hipoksiye sekonder pulmoner hiper- tansif kriz daha sık görülmektedir [9][10][11][12]. Hastanın preoperatif dönemde derin asidoz ve düşük kardiyak debi tablosunda olması çok acil müdahaleyi gerektirir.…”

Does preoperative neutrophil-lymphocyte ratio indicate postoperative morbidity after repair of tetralogy of Fallot?

“…[1,2] The immunological mechanisms and anatomical characteristics are relatively different in children compared to adults. [1,2] The pNLR has been investigated in cardiovascular diseases in search of a powerful predictor of outcome.…”

“…[1,2] The immunological mechanisms and anatomical characteristics are relatively different in children compared to adults. [1,2] The pNLR has been investigated in cardiovascular diseases in search of a powerful predictor of outcome. [3][4][5][6][7][8] However, as the pNLR has not been extensively evaluated in cyanotic pediatric cardiac surgery cases, we investigated whether the pNLR could predict postoperative morbidity in TOF in whom complete repair was performed.…”

“…[1,2] An acute inflammatory response exceeding compensatory response may rapidly lead to endothelial damage, capillary leak, multiple organ failure (MOF), and eventually death, which are more pronounced in pediatric population. [1,2] Recently, preoperative neutrophil-lymphocyte ratio (pNLR) which has been suggested as an indicator of inflammatory status has come into view in cardiovascular diseases as a powerful predictor of outcome. [3][4][5][6][7][8] To the best of our knowledge, although pNLR has been suggested as a valuable predictor of mortality in adults.…”