Perioperative plasma F(2)-Isoprostane levels correlate with markers of impaired ventilation in infants with single-ventricle physiology undergoing stage 2 surgical palliation on the cardiopulmonary bypass.
Cardiopulmonary bypass (CPB) produces inflammation and oxidative stress, which contribute to postoperative complications after cardiac surgery. F(2)-Isoprostanes (F(2)-IsoPs) are products of lipid oxidative injury and represent the most accurate markers of oxidative stress. In adults undergoing cardiac surgery, CPB is associated with elevated IsoPs. The relationship between F(2)-IsoPs and perioperative end-organ function in infants with single-ventricle physiology, however, has not been well studied. This study prospectively enrolled 20 infants (ages 3-12 months) with univentricular physiology undergoing elective stage 2 palliation (bidirectional cavopulmonary anastomosis). Blood samples were collected before the surgical incision (T0), 30 min after initiation of CPB (T1), immediately after separation from CPB (T2), and 24 h postoperatively (T3). Plasma F(2)-IsoP levels were measured at each time point and correlated with indices of pulmonary function and other relevant clinical variables. Plasma F(2)-IsoPs increased significantly during surgery, with highest levels seen immediately after separation from CPB (p < 0.001). After separation from CPB, increased F(2)-IsoP was associated with lower arterial pH (ρ = -0.564; p = 0.012), higher partial pressure of carbon dioxide (PaCO(2); ρ = 0.633; p = 0.004), and decreased lung compliance (ρ = -0.783; p ≤ 0.001). After CPB, F(2)-IsoPs did not correlate with duration of CPB, arterial lactate, or immediate postoperative outcomes. In infants with single-ventricle physiology, CPB produces oxidative stress, as quantified by elevated F(2)-IsoP levels. Increased F(2)-IsoP levels correlated with impaired ventilation in the postoperative period. The extent to which F(2)-IsoPs and other bioactive products of lipid oxidative injury might predict or contribute to organ-specific stress warrants further investigation.
Division of Pediatric Cardiology, Vanderbilt University Medical Center, 2200 Children's Way, Suite 5230, Nashville, TN 37232-6602, USA. erin.albers@vanderbilt.edu
Erin
E
Albers
Brian S
BS
Donahue
Ginger
G
Milne
Benjamin R
BR
Saville
Wenli
W
Wang
David
D
Bichell
BethAnn
B
McLaughlin
D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass; D028441:F2-Isoprostanes / Q000097:blood*; D005500:Follow-Up Studies; D018610:Heart Bypass, Right / Q000009:adverse effects / Q000379:methods*; D006330:Heart Defects, Congenital / Q000097:blood* / Q000503:physiopathology / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery; D006801:Humans; D007223:Infant; D013058:Mass Spectrometry; D018384:Oxidative Stress; D010166:Palliative Care / Q000379:methods*; D059035:Perioperative Period; D011379:Prognosis; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000097:blood* / Q000209:etiology / Q000503:physiopathology
D015415:Biomarkers; D028441:F2-Isoprostanes