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Soluble endothelial adhesion molecules during paediatric cardiovascular surgery with or without cardiopulmonary
Pavel Osmancik1, Jörg Hambsch, Peter Schneider
1Cardiac Centre, University Hospital Kralovske Vinohrady, Charles' University, Prague, Czech Republic.
Insights
Pediatric cardiovascular surgery reduces levels of key endothelial adhesion molecules. Cardiopulmonary bypass exacerbates these reductions, with prolonged recovery of endothelial function in children.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Vascular Endothelium Biology
Background:
- Cardiovascular surgery in children triggers complex inflammatory responses impacting the vascular endothelium.
- The specific endothelial response to cardiosurgical trauma and cardiopulmonary bypass in pediatric patients remains unclear.
Purpose of the Study:
- To investigate the endothelial response to pediatric cardiovascular surgery, with and without cardiopulmonary bypass.
- To assess changes in serum levels of specific endothelial adhesion molecules.
Main Methods:
- Studied 29 children undergoing cardiovascular surgery with cardiopulmonary bypass and 21 without.
- Measured serum levels of soluble E-selectin, P-selectin, and P-selectin glycoprotein ligand-1 via ELISA at multiple time points.
- Compared perioperative and long-term changes in adhesion molecule levels between groups.
Main Results:
- Pediatric cardiovascular surgery significantly decreased serum levels of soluble P-selectin, E-selectin, and P-selectin glycoprotein ligand-1.
- These decreases were more pronounced in patients undergoing cardiopulmonary bypass.
- Adhesion molecule levels returned to preoperative baseline values months after surgery.
Conclusions:
- Endothelial activation, indicated by adhesion molecule release, is reduced during pediatric cardiovascular surgery.
- Cardiopulmonary bypass more significantly perturbs endothelial activity, with effects lasting long after surgery.
Background:
Paediatric cardiovascular surgery with or without cardiopulmonary bypass induces a complex pattern of pro- and anti-inflammatory responses. It is suspected that they may contribute to changes on the vascular endothelium. The endothelial response to cardiosurgical trauma and cardiopulmonary bypass, especially in children, has yet to be well established.
Patients And Methods:
We studied 29 children undergoing cardiovascular surgery with cardiopulmonary bypass, comparing them with 21 not undergoing bypass. The groups did not differ significantly with respect to age, sex, weight and preoperative parameters. Blood samples were drawn 24 h before surgery, after onset of anaesthesia, after onset of cardiopulmonary bypass and after rewarming in those undergoing bypass, or immediately after surgery in the control group, 4 h and 2 days after surgery, at discharge, and months after surgery during out-patient follow-up. Serum levels of soluble E-selectin, P-selectin and P-selectin glycoprotein ligand-1 were measured by enzyme-linked immunoassay.
Results:
Paediatric cardiovascular surgery leads perioperatively to the significant decreases of the serum levels of soluble P- and E-selectin, as well as of soluble P-selectin glycoprotein ligand-1 (all p < 0.05). The time course, and all concentrations, of these molecules were not significantly different with and without bypass. The decreases, however, were more pronounced with cardiopulmonary bypass. Preoperative baseline values were reached months after surgery.
Conclusion:
Endothelial activation of release of adhesion molecules is reduced during paediatric cardiovascular surgery. Endothelial activity is more perturbed with cardiopulmonary bypass and for a long time after surgery.