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Complement activation and cytokine generation after modified Fontan procedure

R D Mainwaring1, J J Lamberti, T E Hugli

  • 1Cardiac Institute, Children's Hospital-San Diego, California, USA.

The Annals of Thoracic Surgery
|July 1, 1998
PubMed
Summary
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Complement and cytokine activation, specifically elevated complement C3 and interleukin-6, may contribute to delayed recovery after the Fontan procedure in single-ventricle patients. Further research is warranted to explore these inflammatory pathways.

Area of Science:

  • Cardiovascular Surgery
  • Immunology
  • Pediatric Cardiology

Background:

  • The Fontan procedure is a palliative surgery for single-ventricle congenital heart defects.
  • Delayed recovery is a common complication post-Fontan procedure.
  • The role of inflammatory responses in delayed recovery is not fully understood.

Purpose of the Study:

  • To investigate the potential contribution of complement activation and cytokine generation to delayed recovery after the Fontan procedure.
  • To measure levels of specific inflammatory markers in patients undergoing the Fontan procedure.

Main Methods:

  • Immunoassay measurements of activated complement C3, thromboxane B2, interleukin-6, and tumor necrosis factor-alpha.
  • Plasma samples collected from 16 patients at multiple time points: preoperatively, during cardiopulmonary bypass, after protamine administration, and 1, 4, 8, and 24 hours postoperatively.

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Main Results:

  • No mortality observed. 3/16 patients experienced low cardiac output, and 5/16 developed pleural effusions.
  • Activated complement C3 levels significantly increased post-bypass and returned to baseline within 24 hours.
  • Interleukin-6 levels showed a significant increase post-procedure, remaining elevated at 24 hours. Thromboxane B2 and TNF-alpha levels did not significantly change.

Conclusions:

  • The study demonstrates significant increases in activated complement C3 and interleukin-6 following the Fontan procedure.
  • These findings suggest that both humoral (complement) and cellular (cytokine) systems are activated.
  • Complement and cytokine activation are implicated as potential contributors to delayed recovery post-Fontan procedure.