Immune Unresponsiveness to Cardiopulmonary Bypass Is Associated With Unfavorable Outcome in Infants Requiring Cardiac...

Area of Science:

• Pediatric cardiac surgery
• Immunology
• Transcriptomics

Background:

• Cardiopulmonary bypass (CPB) triggers complex immune responses, potentially causing complications in pediatric cardiac surgery.
• Infants under 3 months are particularly vulnerable to CPB-related postoperative complications.

Purpose of the Study:

• To investigate the whole blood transcriptomic response to CPB in infants undergoing cardiac surgery.
• To identify immune signatures associated with CPB-induced postoperative complications.
• To evaluate the predictive potential of these signatures for identifying at-risk patients.

Main Methods:

• Whole blood transcriptomic analysis was performed on infants (≤3 months) undergoing cardiac surgery with CPB.
• Immune transcriptomic signatures related to CPB were defined.
• Gene expression differences were compared between patients with complicated and uncomplicated outcomes.
• Preoperative plasma TNFSF12 abundance was assessed for predictive value.

Main Results:

• A distinct immune transcriptomic signature related to CPB was identified.
• Fewer genes (18) were differentially expressed in patients with complicated outcomes compared to the uncomplicated group (>2,000 genes).
• Preoperative plasma TNFSF12 abundance effectively predicted CPB-induced complications, validated in an external cohort.

Conclusions:

• The study defined an immune transcriptomic signature associated with CPB in infants undergoing cardiac surgery.
• Preoperative TNFSF12 levels serve as a promising biomarker for predicting CPB-related complications.
• These findings offer insights into the pathophysiology of CPB-induced complications and potential risk stratification strategies.