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Circulating adhesion molecules in pediatric cardiac surgery

J Boldt¹, C Osmer, L C Linke

¹Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany.

Anesthesia and Analgesia

|December 1, 1995

Summary

Pediatric cardiac surgery patients show higher baseline levels of soluble adhesion molecules (sELAM-1, sICAM-1, sVCAM-1) compared to adults. These levels decrease during cardiopulmonary bypass in children, unlike in adults.

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Area of Science:

Biomedical Engineering
Immunology
Cardiovascular Surgery

Background:

Cardiopulmonary bypass (CPB) can induce systemic inflammation.
Adhesion molecules like ELAM-1, ICAM-1, and VCAM-1 are key in inflammatory responses.
Soluble forms of these molecules may indicate endothelial activation or damage.

Purpose of the Study:

To compare plasma levels of soluble adhesion molecules (sELAM-1, sICAM-1, sVCAM-1) in pediatric versus adult cardiac surgery patients undergoing CPB.
To assess the dynamic changes of these molecules during and after CPB in different age groups.

Main Methods:

Prospective study comparing 15 children (<5 years) with adults undergoing cardiac surgery.
Measurement of plasma sELAM-1, sICAM-1, and sVCAM-1 using enzyme-linked immunosorbent assays.

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Sampling at baseline, during CPB, end of surgery, and postoperative days 1 and 2.

Main Results:

Pediatric patients exhibited significantly higher baseline levels of all three soluble adhesion molecules compared to adults.
sELAM-1 and sICAM-1 levels were notably elevated in children, exceeding normal ranges.
In children, adhesion molecule levels decreased during CPB and remained lower postoperatively, while adult levels showed minimal change.

Conclusions:

Children undergoing CPB have distinct inflammatory profiles characterized by higher baseline soluble adhesion molecule levels.
The observed decrease in soluble adhesion molecules during CPB in children suggests a unique inflammatory response pathway.
These findings highlight age-dependent differences in endothelial activation during pediatric cardiac surgery.