Thorac Cardiovasc Surg 2012; 60 - PP34
DOI: 10.1055/s-0031-1297681

Inflammatory response in newborns and infants undergoing cardiac surgery

R Kubicki 1, J Grohmann 1, J Kroll 2, M Siepe 2, F Humburger 3, C Benk 4, A Rensing-Ehl 5, B Stiller 1
  • 1Universitätsklinikum Freiburg/Zentrum für Kinder- und Jugendmedizin Freiburg, III Angeborene Herzfehler/Pädiatrische Kardiologie, Freiburg, Germany
  • 2Chirurgisches Universitätsklinikum Freiburg, Abteilung Herz- und Gefäßchirurgie, Freiburg, Germany
  • 3Anästhesiologische Universitätsklinik Freiburg, Herz- und Gefäßchirurgische Klinik, Freiburg, Germany
  • 4Universitätsklinikum Freiburg, Herz- und Gefäßchirurgie/Kardiotechnik, Freiburg, Germany
  • 5Universitätsklinikum Freiburg, CCI – Centrum für Chronische Immundefizienz, Freiburg, Germany

Objectives: Prolonged inflammation with capillary leak syndrome (CLS) is associated with increased morbidity after corrective cardiac surgery with cardiopulmonary bypass (CPB). We investigated whether different cytokines, measured with microdialysis, can monitor local inflammation in adipose tissue subcutaneously and predict the development of CLS early, before clinical signs appear.

Methods: We performed a prospective study with serial (0–24h) measurements of local inflammatory response in subcutaneous adipose tissue (microdialysis system CMA 71). 23 infants (14♀) median age 155±22 (range 6–352) days, median body weight 5.4±0.4 (range 2.6–9.2)kg, underwent congenital heart surgery with CPB. Microdialysis catheters were introduced in one lateral thigh subcutaneously using a velocity of 1.0µl/min. Serial blood and microdialysis analysis for cytokines (interleukin [IL]-6, IL-8, IL-10), and complement activation (C3a, C5a) and blood gas analysis were performed. CLS was quantified by X-ray subcutaneous-thoracic ratios (S/T). Additionally, the Vasoactive-Inotrop-Score (VIS) was analyzed.

Results: Median bypass time was 150.4±20.0min and aortic crossclamp was 76.3±12.1min. 6/23 infants developed CLS postoperatively. Younger age and longer bypass time were strongly correlated to the development of CLS. Cytokines and complement activation was measurable subcutaneously in all patients. The highest levels of IL-6 (55.0 [53.25] pg/ml) and IL-8 (65.9 [131.6] pg/ml) were detected two hours after CBP. During surgery the C3a level increased dramatically (167.1 [119.5] ng/ml) followed by a release of IL-10 (5.1 pg/ml) at the end of CBP. Patients with CLS, as compared with those without, showed postoperatively a significant second peak (CLS 63.8ng/ml vs. non-CLS 23.5ng/ml; p<0.001). We could demonstrate an age-related difference between the release of IL-6 and C3a. Longer intubation time (r=0.63; p=0.001), higher inotropic demand, VIS (r=0.67; p=0.001) and higher serological lactate levels (r=0.65; p=0.001) were strongly correlated with IL-6, IL-8 and IL-10 and with CLS.

Conclusion: Diagnostic microdialysis can monitor local inflammation and predict CLS early. This can be useful in further studies, like testing and optimizing miniaturized CPB parts for these high risk patients with small blood volume.