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Soluble adhesion molecules in infants and children undergoing cardiopulmonary bypass
E D Blume1, D P Nelson, K Gauvreau
1Department of Cardiology, Children's Hospital and Harvard Medical School, Boston, Mass 02115, USA.
Insights
Soluble adhesion molecule levels change after cardiopulmonary bypass (CPB) in children. Higher levels in younger, cyanotic patients with longer CPB indicate greater vascular injury risk, aiding new therapy assessment.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Immunology
Background:
- Cardiopulmonary bypass (CPB) can cause vascular injury and tissue damage.
- Leukocyte-endothelial interactions mediated by cell adhesion molecules are key to this injury.
Purpose of the Study:
- To determine the time course of soluble adhesion molecule levels post-CPB in pediatric patients.
- To correlate these levels with preoperative variables, intraoperative management, and postoperative outcomes.
Main Methods:
- Measured plasma concentrations of soluble E-, P-, and L-selectin, ICAM-1, and VCAM-1 in 56 pediatric patients undergoing CPB.
- Utilized sandwich enzyme-linked immunosorbent assays at multiple time points before, during, and after CPB.
- Prospectively recorded preoperative, intraoperative, and postoperative data.
Main Results:
- Soluble adhesion molecule levels initially decreased due to dilution and circuit uptake during CPB.
- Soluble selectins rose significantly in the first 6 hours post-CPB, returning to baseline by 42 hours.
- Soluble ICAM-1 and VCAM-1 increased substantially and remained elevated for 42 hours post-CPB.
- Peak soluble P-selectin correlated with total support time and preoperative cyanosis.
- Soluble L-selectin levels were inversely associated with longer support/arrest times, intubation duration, cyanosis, and younger age.
Conclusions:
- Soluble adhesion molecules exhibit a distinct time course following CPB in pediatric patients.
- Elevated levels are most pronounced in younger, cyanotic patients with longer CPB durations, suggesting higher vascular injury risk.
- These findings may inform the evaluation of novel therapeutic strategies for CPB-induced vascular injury.
Background:
The vascular injury and tissue damage after cardiopulmonary bypass (CPB) involves leukocyte-endothelial interactions mediated by cell adhesion molecules. This study was designed to determine the time course of soluble adhesion molecule levels after CPB in infants and children and to determine whether these levels correlated with preoperative variables, intraoperative bypass management, or postoperative course.
Methods And Results:
In 56 patients undergoing CPB (median age 1.0 year, range 2 days to 19 years), plasma concentrations of soluble E-, P-, and L-selection, soluble ICAM-1, and soluble VCAM-1 were measured using sandwich enzyme-linked immunosorbent assays at the following times: at induction of anesthesia, after 15 minutes of CPB, at the end of CPB, and 1, 6, 18, and 42 hours after CPB. Preoperative, intraoperative, and postoperative data were prospectively recorded. All soluble adhesion molecule levels fell markedly at the initiation of CPB as a result of a combination of dilution and bypass circuit uptake. The time course of soluble selectins (P, E, and L), normalized to end of bypass levels, all rose significantly (P<.001) in the initial 6 hours after CPB and then returned to end bypass levels at 42 hours. Soluble ICAM-1 and VCAM rose 63% and 89% in the first 6 hours and remained elevated throughout the 42 hours. Peak soluble P-selectin levels were associated with total support time (P=.04) and preoperative cyanosis (P=.003). Soluble L-selectin levels were inversely associated with longer total support time (P=.002), longer circulatory arrest time (P=.004), longer length of intubation (P=.0009), preoperative cyanosis (P=.002), and younger age at surgery (P=.01).
Conclusions:
Soluble adhesion molecules have a characteristic time course in infants and children undergoing CPB. The soluble adhesion molecule levels after CPB change most significantly in patients with the highest potential for vascular injury: younger, cyanotic patients with longer pump times and longer postoperative courses. These data may be useful in the assessment of new therapies.