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Randomized comparison between normothermic and hypothermic cardiopulmonary bypass in pediatric open-heart surgery
Massimo Caputo1, Simon Bays, Chris A Rogers
1Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom.
Insights
Normothermic cardiopulmonary bypass (CPB) in pediatric open heart surgery reduces oxidative stress compared to hypothermic CPB. Both methods show similar myocardial reperfusion injury and inflammatory responses, warranting further clinical outcome studies.
Area of Science:
- Cardiology
- Pediatric Surgery
- Biomedical Engineering
Background:
- Pediatric open heart surgery often involves cardiopulmonary bypass (CPB).
- The temperature during CPB can influence patient outcomes.
- Understanding the impact of CPB temperature on myocardial injury and inflammation is crucial.
Purpose of the Study:
- To investigate the effect of CPB temperature on myocardial reperfusion injury.
- To assess the impact of CPB temperature on oxidative stress.
- To evaluate the inflammatory response during pediatric open heart surgery under different CPB temperatures.
Main Methods:
- Fifty-nine children undergoing congenital heart defect correction were randomized to hypothermic (28°C) or normothermic (35-37°C) CPB.
- Biomarkers including Troponin I, 8-isoprostane, C3a, IL-6, IL-8, and IL-10 were measured at multiple time points.
- Measurements were taken preoperatively, during surgery, and up to 24 hours postoperatively.
Main Results:
- Troponin I and 8-isoprostane levels were significantly higher in the hypothermic group compared to the normothermic group.
- Oxidative stress markers (8-isoprostane) were substantially elevated with hypothermic CPB.
- Inflammatory markers (C3a, IL-6, IL-8) were similar between groups, while IL-10 showed a time-dependent difference.
Conclusions:
- Normothermic CPB is associated with reduced oxidative stress in pediatric open heart surgery.
- Myocardial reperfusion injury and systemic inflammatory response were comparable between hypothermic and normothermic CPB.
- Further research with clinical outcomes is recommended to confirm these findings.
Background:
The purpose of this study is to investigate the effect of cardiopulmonary bypass (CPB) temperature on myocardial reperfusion injury, oxidative stress, and inflammatory response in pediatric open heart surgery.
Methods:
Fifty-nine children (median age 78 months; interquartile range, 39-130) undergoing correction of simple congenital heart defects were randomized to receive either hypothermic (28 degrees C) or normothermic (35-37 degrees C) CPB. Troponin I and 8-isoprostane, complement activation C3a, interleukin (IL) -6, -8, and -10, were measured preoperatively, on removal of the aortic cross clamp, 30 minutes, 6, and 24 hours postoperatively.
Results:
Troponin I and 8-isoprostane were significantly raised, compared to baseline, in both groups, and remained high at 24 hours. Overall, troponin I and 8-isoprostane levels were 37% and 84% higher in the hypothermic than in the normothermic group, respectively (ratio 1.37, 95% CI 1.00 to 1.88, p = 0.053 and 1.84, 95% CI 1.22 to 2.78, p = 0.0045, respectively), and there was no evidence to suggest the treatment effect changed significantly over the time points measured (p = 0.63). Adjusting for aortic cross-clamp time reduced the effect of hypothermia on troponin (p = 0.18) but not on 8-isoprostane levels (p = 0.0028). The C3a, IL-6, and IL-8 release was similar in the two groups. The IL-10 release between the groups changed over time (p = 0.059) and examining differences at individual time points highlighted a statistically significant difference at the end of the cross-clamp time (p = 0.0079).
Conclusions:
Normothermic CPB is associated with reduced oxidative stress compared with hypothermic CPB, and similar myocardial reperfusion injury and whole body inflammatory response, in children undergoing open heart surgery. A larger study with clinical outcomes as primary end points is now warranted.
