title: Perioperative serum interleukins in neonates with hypoplastic left-heart syndrome and transposition of the great arteries.
abstract: OBJECTIVE
  The primary study objective was to examine the impact of diagnosis on the inflammatory response in neonates with congenital heart disease undergoing cardiac surgery. The secondary objective was to study the impact of the inflammatory response on postoperative outcome in these neonates.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Tertiary care children's hospital heart center.
  
  
  METHODS
  Neonates with hypoplastic left-heart syndrome (HLHS) undergoing stage I repair and patients with transposition of the great arteries (TGA) undergoing arterial switch operation.
  
  
  RESULTS
  There were 24 neonates with HLHS and 21 neonates with TGA. Serum samples to measure interleukin (IL)-6 and -10 were obtained before and after CPB at 1, 3, 6, and 24 hours postoperatively. Time to extubation, intensive care unit (ICU) length of stay, and peritoneal fluid drainage were compared between the groups. Serum IL-6 and IL-10 concentrations increased after CPB when compared to the preoperative concentration. Preoperative concentrations of IL-6 were significantly elevated in the HLHS group (HLHS: 32 [21.1, 69.6] pg/mL v TGA: 7.2 [3.6, 22.5] pg/mL [median, 25th, and 75th percentile], p = 0.003) and remained elevated immediately after CPB, and at 3 and 6 hours postoperatively. The IL-10 to IL-6 ratio was lower in the HLHS group preoperatively and immediately after CPB. ICU length of stay was significantly longer in the HLHS group (TGA 4 [3-6] days v HLHS 6 [5-8] days, p = 0.031). Mortality in the HLHS group (4/24) was associated with significantly higher IL-6 postoperatively (IL-6 immediately postoperatively: HLHS survivors 59.9 [34.3, 65.7] pg/mL v nonsurvivors 98.7 [94.4, 104.5] pg/mL, p < 0.011).
  
  
  CONCLUSIONS
  All neonates with TGA or HLHS have a significant inflammatory response after CPB. Neonates with HLHS have evidence of an activated inflammatory response before CPB, which remains significant in the postoperative period. Accelerated interleukin expression and an abnormal cytokine balance correlate with longer time to extubation, longer ICU length of stay, and increased peritoneal fluid volume.
authors.affiliation: Department of Pediatric Critical Care, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. appache@ccf.org
authors.forename: Elumalai
authors.initials: E
authors.lastname: Appachi
authors.forename: Emad
authors.initials: E
authors.lastname: Mossad
authors.forename: Roger B B
authors.initials: RB
authors.lastname: Mee
authors.forename: Paula
authors.initials: P
authors.lastname: Bokesch
mesh_terms: D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000097:blood* / Q000601:surgery*; D007231:Infant, Newborn; D018836:Inflammation Mediators / Q000097:blood; D007363:Intensive Care Units, Neonatal; D016753:Interleukin-10 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D007902:Length of Stay; D011184:Postoperative Period; D012107:Research Design; D016019:Survival Analysis; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000097:blood* / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D015850:Interleukin-6; D016753:Interleukin-10