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Immune dysfunction in children after corrective surgery for congenital heart disease
G J Hauser1, M M Chan, W F Casey
1Department of Critical Care Medicine, Georgetown University Children's Medical Center, Washington, DC 20007.
Objective:
To study the effect of open- and closed-heart surgery on the immune status of infants and children.
Design:
Prospective study. Data collected before anesthesia and surgery and 2 and 24 hrs after surgery.
Setting:
Operating room and pediatric ICU in a children's hospital.
Patients:
Children undergoing surgery for correction of congenital heart disease (age 3 months to 12 yrs). A total of 31 patients were studied (open-heart surgery, n = 25; closed-heart surgery, n = 6).
Measurements And Main Results:
Increased neutrophil counts and lymphopenia were observed after both open- and closed-heart surgery. Serum levels of the complement components C3 and C4 were depressed after open-heart surgery, but not after closed procedures. The percentage of T3+ and T4+ lymphocytes, proliferative responses of the lymphocytes and serum immunoglobulin (Ig)G and IgM were decreased from preoperative levels after open-heart surgery. The percentage of T8+ lymphocytes and serum IgA levels did not change. Intraoperative variables and postoperative severity of illness (Pediatric Risk of Mortality score) did not correlate with immune suppression.
Conclusions:
The immune system is affected after pediatric cardiac surgery, particularly after open-heart surgery.