Influence of two different perfusion systems on inflammatory response in pediatric heart surgery.

• BACKGROUND: This study tests the hypothesis that a cardiopulmonary bypass system that combines complete heparin-coating, a centrifugal pump, and a closed circuit in comparison with a conventional system (uncoated system, roller pump, and hard shell venous reservoir) attenuates the inflammatory response in pediatric heart surgery. METHODS: In a prospective randomized controlled clinical study 40 consecutive children weighing 10 kg or less were included and divided into two groups. Concentrations of complement proteins (C3a, sC5b-9, C4d, and Bb), granulocyte degranulation products (polymorphonuclear [PMN] elastase), and proinflammatory cytokines (tumor necrosis factor [TNF]-alpha, interleukin [IL]-6, and IL-8) were measured. RESULTS: C3a and sC5b-9 concentrations were lower (C3a, p < 0.001; sC5b-9, p = 0.01) in the combined (heparin-coated/centrifugal pump/closed reservoir) group, the peak values being 58% and 37% of conventional group values. The Bb- and C4d-fragment values indicated activation of the complement system through the alternative pathway in both groups. PMN elastase concentrations were lower (p = 0.02) in the combined group, the peak values being 43% of conventional group values. There were no significant intergroup differences regarding TNF-alpha, IL-6, or IL-8 concentrations. CONCLUSIONS: The use of a fully heparin-coated system, a centrifugal pump, and a closed circuit during CPB in children (10 kg or less) leads to a lower degree of complement activation and PMN elastase release compared with a conventional system.

Nyckelord

Adolescent

Cardiopulmonary Bypass

instrumentation

Child

Child

Preschool

Coated Materials

Biocompatible

Complement Activation

immunology

Equipment Design

Female

Heart Defects

Congenital

surgery

Heparin

Humans

Infant

Inflammation Mediators

blood

Interleukin-6

blood

Interleukin-8

blood

Leukocyte Elastase

blood

Male

Postoperative Complications

immunology

prevention & control

Systemic Inflammatory Response Syndrome

immunology

prevention & control

Tumor Necrosis Factor-alpha

metabolism

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