Cardiac surgery with deep hypothermic circulatory arrest produces less systemic inflammatory response than low-flow cardiopulmonary bypass in newborns.
OBJECTIVE
We sought to compare low-flow cardiopulmonary bypass with deep hypothermic circulatory arrest in respect to the influence on the systemic inflammatory response.


METHODS
Twenty-three infants weighing less than 10 kg and scheduled for repair of congenital malformations were enrolled in a randomized, controlled study. Eleven patients underwent cardiac surgery with deep hypothermic circulatory arrest (the DHCA group). Low-flow cardiopulmonary bypass was used in another 12 patients (the LF group). Interleukin 6 and 8 and anaphylatoxin C3a levels were measured 6 times perioperatively. Also, perioperative weight gain and a radiologic soft-tissue index were compared.


RESULTS
All patients had an uneventful clinical course. Duration of deep hypothermic circulatory arrest was 40 +/- 4 minutes; the bypass time was significantly shorter in the DHCA group (85 +/- 8 vs 130 +/- 19 minutes). However, the duration of the operation was similar in both groups (245 +/- 30 vs 246 +/- 30 minutes). During cardiopulmonary bypass (rewarming), the concentration of C3a (3751 +/- 388 vs 5761 +/- 1688 ng/mL, mean +/- SEM) was significantly lower in the DHCA group than in the LF group. The interleukin 8 level was significantly lower, and the interleukin 6 level had a tendency to be lower in the DHCA group compared with levels in the LF group. There was less weight gain on the first postoperative day in the DHCA group (65 +/- 61 vs 408 +/- 118 g). The soft-tissue index suggested reduced edema formation in the DHCA group.


CONCLUSIONS
Deep hypothermic circulatory arrest produces less systemic inflammatory response than low-flow cardiopulmonary bypass. In addition, there is an indication of less fluid accumulation postoperatively.
Tassani
P
P
Department of Anesthesiology, Deutsches Herzzentrum München, München, Germany. tassani@dhm.mhn.de
Barankay
A
A
Haas
F
F
Paek
S U
SU
Heilmaier
M
M
Hess
J
J
Lange
R
R
Richter
J A
JA
D001794:Blood Pressure / Q000187:drug effects; D001835:Body Weight / Q000502:physiology; D002315:Cardiopulmonary Bypass; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003167:Complement Activation; D015926:Complement C3a / Q000276:immunology / Q000378:metabolism; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D006324:Heart Arrest, Induced; D006330:Heart Defects, Congenital / Q000097:blood / Q000150:complications / Q000601:surgery; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007036:Hypothermia, Induced; D007223:Infant; D007229:Infant Welfare; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D018836:Inflammation Mediators; D015850:Interleukin-6; D016209:Interleukin-8; D004280:Dobutamine; D015926:Complement C3a; D004298:Dopamine