Effect of C1-esterase-inhibitor on capillary leak and inflammatory response syndrome during arterial switch operations in neonates.
OBJECTIVE
To determine if prophylactic administration of C1-esterase-inhibitor would have a beneficial effect on postoperative weight gain and the inflammatory response in neonates undergoing cardiac surgery with cardiopulmonary bypass (CPB).


METHODS
Randomized, double-blinded study.


METHODS
University-affiliated heart center.


METHODS
Twenty-four neonates with transposition of the great arteries.


METHODS
In group inhibitor (INH) patients (n = 12), 100 IU/kg of C1-esterase-inhibitor (Berinert) was given 30 minutes before CPB. In group placebo (P) patients (n = 12), placebo was administered instead. Interleukin (IL)-6, C3a anaphylatoxin, C1 activity, prekallikrein, Hageman factor, D-dimers, and clinical parameters were measured 6 times perioperatively.


RESULTS
All 24 patients had an uneventful clinical course. Mean arterial pressure and pulmonary oxygenation after CPB were superior in group INH patients. The weight gain on postoperative days 1 to 4 was significantly less in group INH patients compared with group P (55 +/- 59 g vs. 340 +/- 121 g, day 1). The concentration of IL-6 (76 +/- 17 pg/mL vs. 262 +/- 95 pg/mL during CPB) was significantly lower in group INH patients compared with group P patients. In contrast, no influence on C3a anaphylatoxin and coagulation factors was found.


CONCLUSIONS
Prophylactic application of C1-esterase-inhibitor in neonates undergoing arterial switch operations produces less inflammatory response compared with placebo. This difference may have contributed to improved clinical parameters, including less weight gain postoperatively.
Tassani
P
P
Department of Anesthesiology, German Heart Center Munich, Germany. tassani@dhm.mhn.de
Kunkel
R
R
Richter
J A
JA
Oechsler
H
H
Lorenz
H P
HP
Braun
S L
SL
Eising
G P
GP
Haas
F
F
Paek
S U
SU
Bauernschmitt
R
R
Jochum
M
M
Lange
R
R
D019559:Capillary Leak Syndrome / Q000209:etiology / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003172:Complement C1 / Q000032:analysis; D003174:Complement C1 Inactivator Proteins / Q000627:therapeutic use*; D015926:Complement C3a / Q000032:analysis; D004311:Double-Blind Method; D005174:Factor XII / Q000032:analysis; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D007231:Infant, Newborn; D015850:Interleukin-6 / Q000097:blood; D011288:Prekallikrein / Q000032:analysis; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000517:prevention & control*; D014188:Transposition of Great Vessels / Q000601:surgery*; D015430:Weight Gain / Q000187:drug effects
D003172:Complement C1; D003174:Complement C1 Inactivator Proteins; D005338:Fibrin Fibrinogen Degradation Products; D015850:Interleukin-6; C036309:fibrin fragment D; D015926:Complement C3a; D005174:Factor XII; D011288:Prekallikrein