Elimination of proinflammatory cytokines in pediatric cardiac surgery: analysis of ultrafiltration method and filter type.
OBJECTIVE
This study was undertaken to assess whether different filter types or ultrafiltration methods influence inflammatory markers in pediatric cardiac surgery.


METHODS
Forty-one children younger than 5 years were prospectively randomized to groups A (polyamid filter with conventional ultrafiltration), B (polyamid filter with modified ultrafiltration), C (polysulfon filter with conventional ultrafiltration), and D (polysulfon filter with modified ultrafiltration). Interleukin 6, interleukin 10, tumor necrosis factor, terminal complement complex, and lactoferrin were measured before the operation (T0), before rewarming (T1), after ultrafiltration (T2), at 6 (T3) and 18 hours (T4) after the operation, and in the ultrafiltrate.


RESULTS
All markers changed with both ultrafiltration methods, both filter types, and in all groups (except tumor necrosis factor) along the T0 to T4 observation time (P <.0001). Their patterns of changes were different for terminal complement complex, with less decrease after use of the polysulfon filter (P <.05), and among groups A through D for interleukin 6 (P =.01), with more decrease in group C than group A (P <.02). Interleukin 10 decreased with the polyamid filter (P <.001) but not with the polysulfon filter. In the ultrafiltrate, tumor necrosis factor was higher with the polysulfon filter than the polyamid filter (6.8 +/- 5 pg/mL vs 4.0 +/- 3.7 pg/mL, P <.05). The ultrafiltrate/plasma ratio of interleukin 6 was higher with conventional ultrafiltration than modified ultrafiltration (0.018 +/- 0.017 vs 0.004 +/- 0.007, P <.005).


CONCLUSIONS
The polysulfon filter showed a filtration profile for inflammatory mediators superior to that of the polyamid filter for interleukin 6, tumor necrosis factor, and interleukin 10. Interleukin 6 was most efficiently removed by conventional ultrafiltration with a polysulfon filter, and tumor necrosis factor was best removed by modified ultrafiltration with a polysulfon filter, whereas other inflammatory mediators were not influenced by filter type or ultrafiltration method. Therefore combined conventional and modified ultrafiltration with a polysulfon filter may currently be the most effective strategy for removing inflammatory mediators in pediatric heart surgery.
Berdat
Pascal A
PA
Clinic for Cardiovascular Surgery, University Hospital, Bern, Switzerland. pascal.berdat@insel.ch
Eichenberger
Evelyne
E
Ebell
Julia
J
Pfammatter
Jean-Pierre
JP
Pavlovic
Mladen
M
Zobrist
Claudia
C
Gygax
Erich
E
Nydegger
Urs
U
Carrel
Thierry
T
D015415:Biomarkers / Q000032:analysis; D006348:Cardiac Surgical Procedures / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000295:instrumentation* / Q000379:methods; D002675:Child, Preschool; D015926:Complement C3a / Q000032:analysis; D015938:Complement Membrane Attack Complex / Q000032:analysis; D016207:Cytokines / Q000032:analysis / Q000378:metabolism*; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006440:Hemofiltration / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis / Q000378:metabolism*; D016753:Interleukin-10 / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis; D007781:Lactoferrin / Q000032:analysis; D008297:Male; D008851:Micropore Filters; D008991:Monitoring, Physiologic; D011182:Postoperative Care; D011184:Postoperative Period; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D015415:Biomarkers; D015938:Complement Membrane Attack Complex; D016207:Cytokines; D018836:Inflammation Mediators; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D015926:Complement C3a; D007781:Lactoferrin