Influence of two different perfusion systems on inflammatory response in pediatric heart surgery.
BACKGROUND
This study tests the hypothesis that a cardiopulmonary bypass system that combines complete heparin-coating, a centrifugal pump, and a closed circuit in comparison with a conventional system (uncoated system, roller pump, and hard shell venous reservoir) attenuates the inflammatory response in pediatric heart surgery.


METHODS
In a prospective randomized controlled clinical study 40 consecutive children weighing 10 kg or less were included and divided into two groups. Concentrations of complement proteins (C3a, sC5b-9, C4d, and Bb), granulocyte degranulation products (polymorphonuclear [PMN] elastase), and proinflammatory cytokines (tumor necrosis factor [TNF]-alpha, interleukin [IL]-6, and IL-8) were measured.


RESULTS
C3a and sC5b-9 concentrations were lower (C3a, p < 0.001; sC5b-9, p = 0.01) in the combined (heparin-coated/centrifugal pump/closed reservoir) group, the peak values being 58% and 37% of conventional group values. The Bb- and C4d-fragment values indicated activation of the complement system through the alternative pathway in both groups. PMN elastase concentrations were lower (p = 0.02) in the combined group, the peak values being 43% of conventional group values. There were no significant intergroup differences regarding TNF-alpha, IL-6, or IL-8 concentrations.


CONCLUSIONS
The use of a fully heparin-coated system, a centrifugal pump, and a closed circuit during CPB in children (10 kg or less) leads to a lower degree of complement activation and PMN elastase release compared with a conventional system.
Jensen
Eva
E
Department of Pediatric Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden. ev.jensen@telia.com
Andréasson
Svenerik
S
Bengtsson
Anders
A
Berggren
Håkan
H
Ekroth
Rolf
R
Lindholm
Lena
L
Ouchterlony
John
J
D000293:Adolescent; D002315:Cardiopulmonary Bypass / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D020099:Coated Materials, Biocompatible; D003167:Complement Activation / Q000276:immunology; D004867:Equipment Design; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006493:Heparin; D006801:Humans; D007223:Infant; D018836:Inflammation Mediators / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D011183:Postoperative Complications / Q000276:immunology* / Q000517:prevention & control; D018746:Systemic Inflammatory Response Syndrome / Q000276:immunology* / Q000517:prevention & control; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D020099:Coated Materials, Biocompatible; D018836:Inflammation Mediators; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D006493:Heparin; D019272:Leukocyte Elastase