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Cardiopulmonary Bypass and Infant Vaccination Titers
Jeffrey Vergales1, Peter Dean2, Jacob Raphael3
1Divisions of Pediatric Cardiology and jvergales@virginia.edu.
Insights
Infant vaccine antibody titers are minimally impacted by cardiopulmonary bypass (CPB) during heart surgery. This suggests that the recommended vaccination schedule can likely continue for infants undergoing congenital heart surgery.
Area of Science:
- Pediatric Cardiology
- Immunology
- Infectious Disease Prevention
Background:
- Infants with congenital heart disease are susceptible to preventable infections.
- Immunization is crucial for reducing infection risk in these vulnerable infants.
- The impact of cardiac surgery with cardiopulmonary bypass (CPB) on infant immunization status is not well understood.
Purpose of the Study:
- To evaluate the effect of cardiopulmonary bypass (CPB) on infant vaccination status following cardiac surgery.
- To determine if CPB significantly alters antibody titers in infants undergoing heart surgery.
Main Methods:
- Prospective observational study of 98 infants (2-14 months) who received infant vaccinations and required cardiac surgery with CPB.
- Antibody titers measured before and after CPB.
- Regression analysis used to assess demographic and surgical variables' impact on titer changes.
Main Results:
- No significant difference in antibody titers for diphtheria, tetanus, polio, or *Haemophilus influenzae* post-CPB.
- Minor reductions observed in *Bordetella* and hepatitis B titers, but remained above protective thresholds.
- Changes in antibody titers were not linked to surgical timing, patient age/weight, blood products, CPB duration, or heterotaxy.
Conclusions:
- Cardiopulmonary bypass has minimal effect on infant vaccine antibody titers.
- No easily modifiable surgical variables were associated with significant titer changes.
- Maintaining the standard vaccination schedule is likely appropriate for infants undergoing congenital heart surgery.
Background:
Infants with congenital heart disease remain vulnerable to potentially preventable pathogens. Although immunization can significantly reduce this risk, it is unknown how immunization status can be affected by cardiac surgery with cardiopulmonary bypass (CPB). The objective was to evaluate the effect of CPB on infant vaccination status after cardiac surgery.
Methods:
We conducted a prospective observational study of patients between 2 and 14 months of age who had received at least their first round of infant vaccinations and who required cardiac surgery with CPB. Antibody titers were measured before CPB and again the following morning. Demographic and surgical variables were assessed via regression methods for their effects on the change in titers.
Results:
Among the 98 patients followed, there was no demonstrated difference between the pre- and postoperative values in regard to diphtheria, tetanus, polio 1, polio 3, or Haemophilus influenzae titers. Bordetella (1.03 vs 0.84, P < .001), and hepatitis B (log 2.10 vs 1.89, P = .001) titers did reduce after CPB but did not fall below the immunized threshold. Changes in antibody titers were not associated with time between immunization and surgery, age or weight at surgery, blood products administered, number of previous doses, time on CPB, or heterotaxy diagnosis for most of the vaccines.
Conclusions:
Infant vaccine antibody titers were minimally affected by CPB and not associated with any easily modifiable surgical variables. Although antibody titers are only 1 marker of immunity, deviation from the recommended vaccination schedule may be unnecessary for children requiring congenital heart surgery.
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