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The distinct contribution of sternotomy to the systemic inflammatory response during children's heart surgery

Joel David Bierer1, Julia Paffile2, Roger Stanzel3

  • 1Division of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada.

Frontiers in Immunology
|January 19, 2026
PubMed

Insights

Sternotomy in pediatric cardiac surgery triggers a specific inflammatory response dominated by cytokines and chemokines, distinct from cardiopulmonary bypass inflammation. This finding clarifies the immune response to surgical procedures in children.

Area of Science:

  • Pediatric cardiac surgery
  • Inflammatory response
  • Mediator profiling

Background:

  • Sternotomy is a standard surgical approach for pediatric congenital cardiac surgery.
  • The inflammatory impact of sternotomy, especially alongside cardiopulmonary bypass (CPB), is not fully understood.
  • This study differentiates the inflammatory profiles of sternotomy versus CPB.

Purpose of the Study:

  • To characterize the inflammatory mediator profile specifically induced by sternotomy.
  • To contrast the sternotomy-induced inflammatory response with that of cardiopulmonary bypass (CPB).
  • To identify key inflammatory mediators associated with sternotomy in pediatric cardiac surgery.

Main Methods:

  • Post-hoc analysis of a prospective study involving 40 pediatric patients undergoing congenital cardiac surgery with CPB.
  • Arterial blood samples collected pre- and post-sternotomy (before CPB) and post-CPB.
  • Measurement of 33 inflammatory mediators (cytokines, chemokines, complement, adhesion molecules) and analysis using median fold changes and principal component analysis with hierarchical clustering (PCA-HCPC).

Main Results:

  • Sternotomy significantly increased 16 cytokines and chemokines, with IL-1β, CXCL2, and IL-6 being most prominent.
  • Complement and adhesion molecules showed static or decreased levels post-sternotomy.
  • PCA-HCPC identified distinct clusters, separating sternotomy-induced cytokines/chemokines from complement and adhesion molecules, highlighting sternotomy's specific inflammatory contribution.

Conclusions:

  • Sternotomy and associated tissue trauma generate a unique inflammatory profile characterized by pro-inflammatory cytokines and chemokines.
  • Complement activation is not a primary feature of the sternotomy response.
  • Mediators like IL-6, CXCL8, IL-1Ra, and IL-10 are sequentially induced by both sternotomy and CPB, indicating sequential immune stimulation during cardiac operations.
Abstract

Keywords:
cardiopulmonary bypasschemokinecomplementcongenital heart diseasecytokineincisionpediatric cardiac surgerysternotomy

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