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Andreas Böning1, Jens Scheewe, Thomas Ivers
1Department of Cardiovascular Surgery, University Hospital, Kiel, Germany. aboening@kielheart.uni-kiel.de
Insights
This study compared two pediatric oxygenators during cardiac surgery. Adequate priming volume is key to managing inflammatory responses and capillary leak syndrome in infants undergoing extracorporeal circulation.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomaterials Science
Background:
- Extracorporeal circulation in pediatric cardiac surgery can trigger systemic inflammatory response and capillary leak syndrome.
- Optimizing oxygenator design and function is crucial for mitigating these adverse effects in neonates and infants.
Purpose of the Study:
- To investigate the influence of two pediatric-specific oxygenators (Medtronic Minimax and Dideco Lilliput 1) on inflammatory markers and clinical outcomes.
- To evaluate the impact of priming volume on systemic inflammatory response and capillary leak syndrome.
Main Methods:
- Prospective randomized study involving 40 neonates and infants undergoing cardiac surgery with extracorporeal circulation.
- Comparison of Medtronic Minimax (750 mL prime) vs. Dideco Lilliput 1 (750 mL and 450 mL prime).
- Measurement of inflammatory markers (IL-6, TNF-alpha, elastase, C3, free hemoglobin) and hematologic parameters (erythrocytes, leukocytes, thrombocytes, hemoglobin, CRP).
Main Results:
- Peak inflammatory markers (TNF-alpha, IL-6, elastase, free hemoglobin) observed during or within 4 hours post-operation.
- Higher IL-6 and TNF-alpha values noted with Lilliput/750 compared to Minimax and Lilliput/450.
- Younger age correlated with increased risk of capillary leak syndrome; Lilliput/750 group had more complicated courses.
Conclusions:
- Adequate priming volume ensures similar systemic inflammatory response between Dideco Lilliput 1 and Medtronic Minimax oxygenators.
- Surface coatings (heparin or phosphorylcholine) demonstrate comparable biological effects in pediatric cardiac surgery patients.
Objective:
Cardiac surgery for complex congenital malformations with use of extracorporeal circulation predisposes to an excessive systemic inflammatory response and a consecutive capillary leak syndrome. In a prospective randomized study the influence of 2 oxygenators especially designed for pediatric use on inflammatory markers and clinical outcome was investigated.
Methods:
Forty neonates and infants (body surface area, <0.36 m(2)) undergoing cardiac surgery with extracorporeal circulation were randomized into one of 3 groups: in the first group (n = 14) the Medtronic Minimax Oxygenator and in the second group (n = 12) the Dideco Lilliput 1 Oxygenator, both with a 750-mL priming volume, were used. In the third group the Dideco Lilliput 1 Oxygenator was filled with a reduced priming volume of 450 mL. Parameters of interest for evaluation of a systemic inflammatory response after extracorporeal circulation were interleukin 6, tumor necrosis factor alpha, neutrophil elastase, complement C3, and free hemoglobin. In addition, erythrocyte, leukocyte, and thrombocyte counts and hemoglobin and C-reactive protein values were determined at different measurement points before, during, and after the operation.
Results:
In all 3 groups peak values for tumor necrosis factor alpha were observed during the operation, whereas interleukin 6, elastase, and free hemoglobin values peaked in the first 4 hours. The highest values for leukocytes and C-reactive protein were obtained between 24 and 72 hours after the operation. Erythrocyte and thrombocyte counts, as well as hemoglobin values, were lowest at extracorporeal circulation onset, normalizing under substitution in the first 4 hours after the operation. By using the Lilliput/750 oxygenator, higher interleukin 6 values 1 and 4 hours after the operation and higher tumor necrosis factor alpha values during and 1 hour after the operation could be observed compared with results with the Minimax and Lilliput/450 oxygenators. In spite of our randomization protocol, patients in the Lilliput/750 group were significantly smaller and younger than those in the Minimax group. However, the statistical analysis showed no correlation between age and interleukin 6 or tumor necrosis factor alpha values, but it did show a correlation between younger age and the occurrence of capillary leak syndrome. Accordingly, the number of children with clinically complicated course (capillary leak, longer duration of catecholamine therapy, and ventilation) was higher in the Lilliput/750 group than in the Minimax group.
Conclusion:
By using an adequate priming volume, the systemic inflammatory response is similar after use of the Dideco Lilliput 1 Oxygenator and the Medtronic Minimax Oxygenator. Tip-to-tip surface coating of the extracorporeal circulation with either heparin or phosphorylcholine seems to have similar biologic effects in neonates and infants undergoing cardiac surgery.
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