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Hemoadsorption Contribution in Failing Fontan Pediatric Heart Transplantation
Carlo Pace Napoleone1, Enrico Aidala1, Maria Teresa Cascarano1
1Pediatric and Congenital Cardiac Surgery, Regina Margherita Children's Hospital, Torino, Italy.
Insights
This study shows that using a hemoadsorption filter during pediatric heart transplantation significantly reduced inflammatory markers. This approach improved outcomes in a high-risk patient, suggesting a potential benefit for complex pediatric transplant cases.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Pediatric cardiothoracic surgery with cardiopulmonary bypass (CPB) can trigger a systemic inflammatory response, particularly in high-risk patients.
- This inflammatory response can negatively impact surgical outcomes.
- Adsorptive blood purification is explored as a method to mitigate this response.
Observation:
- A 10-year-old pediatric heart transplant recipient with a failing Fontan circulation and compromised condition was treated.
- The Jafron HA 380 hemoadsorption filter was integrated throughout the cardiopulmonary bypass (CPB) period.
- Interleukin-6 (IL-6), an inflammatory biomarker, was monitored.
Findings:
- The patient experienced an uneventful postoperative recovery, comparable to elective pediatric heart transplants.
- IL-6 levels demonstrated a significant reduction post-surgery.
- Postoperative IL-6 levels normalized within two days, aligning with typical uneventful transplant courses.
Implications:
- Hemoadsorption filtration may enhance outcomes in pediatric heart transplantation.
- This technique shows promise for improving results in very high-risk pediatric transplant recipients.
- Further research into adsorptive techniques in pediatric cardiac surgery is warranted.
Introduction:
A systemic inflammatory response is triggered in patients undergoing cardiothoracic surgery with cardiopulmonary bypass (CPB). This response is particularly evident in pediatric patients, especially those of low weight and after undergoing long CPB, and can severely impair the surgical result. Adsorptive blood purification techniques have been proposed to limit this systemic inflammatory response. To test its efficacy, we added the hemoadsorption filter Jafron HA 380 to CPB in a much compromised pediatric patient who underwent heart transplantation.
Methods:
A 10-year-old single ventricle patient previously treated with Fontan operation was listed for heart transplantation due to the evidence of failing Fontan condition. He experienced many episodes of cardiac arrest and underwent heart transplantation in much compromised general and hemodynamic conditions. The hemoadsorption filter Jafron HA 380 was used for all the duration of CPB, and the inflammatory biomarker interleukin 6 (IL-6) was assayed.
Results:
Postoperative outcome was uneventful and comparable to that of elective pediatric heart transplantation. IL-6 levels showed an impressive postoperative reduction, and after 2 days, the IL-6 level was comparable with a typical uneventful post-transplant course.
Conclusions:
The use of hemoadsorption filter can contribute to improve the pediatric transplant results, especially in very high-risk patients.
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