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Cytokines and pediatric open heart surgery with cardiopulmonary bypass
M V Carvalho1, M A Maluf, R Catani
1Division of Cardiac Surgery, Federal University of São Paulo-Escola Paulista de Medicina, Brasil.
Insights
Inflammatory markers, including tumor necrosis factor-alpha and interleukin-6, increase after pediatric open-heart surgery. These cytokine levels correlate with lactate and the need for inotropic drugs post-surgery.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Immunology
Background:
- Cardiopulmonary bypass can trigger a systemic inflammatory response in children undergoing open-heart surgery.
- Cytokines, such as tumor necrosis factor-alpha and interleukin-6, are implicated in this post-operative inflammatory syndrome.
Purpose of the Study:
- To investigate the behavior of tumor necrosis factor-alpha and interleukin-6 during and after pediatric open-heart surgery.
- To explore correlations between these cytokine levels, cardiopulmonary bypass duration, lactate levels, and inotropic drug use.
Main Methods:
- Serum samples were collected from pediatric patients at multiple time points: pre-anesthesia, during cardiopulmonary bypass, and 2 and 24 hours post-bypass.
- Levels of tumor necrosis factor-alpha and interleukin-6 were quantified using immunoassay techniques.
- Statistical analyses were performed to assess relationships between cytokine levels and clinical variables.
Main Results:
- Tumor necrosis factor-alpha and interleukin-6 levels significantly increased from baseline to 2 hours post-bypass.
- No correlation was found between cytokine levels and the duration of cardiopulmonary bypass.
- Interleukin-6 levels showed a positive correlation with lactate levels at 2 hours post-bypass.
- Measured cytokine levels correlated with the extent of inotropic drug administration in the postoperative period.
Conclusions:
- Pediatric open-heart surgery induces a transient increase in pro-inflammatory cytokines, tumor necrosis factor-alpha and interleukin-6.
- While bypass duration is not directly linked, elevated cytokine levels are associated with metabolic markers (lactate) and the need for circulatory support (inotropic drugs).
- These findings highlight the inflammatory impact of cardiac surgery in children and suggest potential biomarkers for post-operative complications.
Abstract:
It is well known that, subsequent to cardiopulmonary bypass, and particularly in children, an inflammatory response within the body can often result in a characteristic syndrome. Recently, it has been suggested that this phenomenon is due to a systemic inflammatory response, with significant involvement of cytokines. With this in mind, we investigated the behavior of tumour necrosis factor-alpha and interleukin-6 during the operative and in the immediate postoperative period in a group of children submitted to open heart surgery. We investigated any possible relation between the levels of these cytokines in the serum and the length of cardiopulmonary bypass, with the serum levels of lactate, and with the extent of use of inotropic drugs in postoperative period. The cytokines were measured in samples withdrawn after induction of anesthesia, after 10 minutes of cardiopulmonary bypass, after re-establishment of circulation, and then 2 and 24 hours after the end of cardiopulmonary bypass. The levels of tumour necrosis factor-alpha and interleukin-6 increased between the beginning and at two hours of the end of cardiopulmonary bypass. There was no correlation between the levels of these cytokines in the serum and the length of cardiopulmonary bypass, although there was a positive relation between levels of interleukin-6 and lactate in samples withdrawn at two hours of the end of bypass, and the measured levels of the cytokines correlated with the extent of inotropic drugs employed in the postoperative period.