title: Perioperative levels of tumor necrosis factor-α correlate with outcomes in children and adults with tetralogy of Fallot undergoing corrective surgery.
abstract: BACKGROUND
  Previous studies reporting on tumor necrosis factor-α (TNF-α) as a marker of inflammatory response (IR) in patients with congenital heart disease were limited by small sample size and variability in diagnosis. We report perioperative changes in TNF-α levels and their correlation with preoperative factors and clinical outcomes in a large homogenous group of patients with tetralogy of Fallot (TOF) undergoing definitive repair at a tertiary care center.
  
  
  METHODS
  A total of 167 patients were divided into four groups on the basis of age. Group 1 included infants less than 1 year, group 2 included children between 1 and 12 years, group 3 included adolescents between 12 and 18 years, and group 4 included adults more than 18 years of age. Serum TNF-α levels were measured at three time points and correlated with perioperative variables.
  
  
  RESULTS
  The baseline TNF-α level correlated with patients' nutritional status and degree of cyanosis in all four groups. The magnitude of IR in the postcardiopulmonary bypass (post-CPB) period as measured by TNF-α level was much higher and correlated more consistently with adverse clinical outcomes in the younger age group (groups 1 and 2). On multivariable analysis; age at operation, preoperative degree of hypoxemia and TNF-α levels were found to be independent predictors of clinical outcomes.
  
  
  CONCLUSIONS
  We demonstrated a rise in serum TNF-α levels in patients with TOF undergoing definitive repair on CPB, which correlated with preoperative severity of cyanosis, nutritional status, and adverse clinical outcomes. The TNF-α levels may be monitored to identify cyanotic patients at an increased risk of exhibiting augmented IR to CPB.
authors.affiliation: Department of Cardiac Anesthesiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
authors.forename: Brijindera Singh
authors.initials: BS
authors.lastname: Sethi
authors.forename: Poonam Malhotra
authors.initials: PM
authors.lastname: Kapoor
authors.forename: Sandeep
authors.initials: S
authors.lastname: Chauhan
authors.forename: Ujjwal K
authors.initials: UK
authors.lastname: Chowdhury
authors.forename: Usha
authors.initials: U
authors.lastname: Kiran
authors.forename: Minati
authors.initials: M
authors.lastname: Choudhury
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D017558:Elective Surgical Procedures; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D008297:Male; D019990:Perioperative Care; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013771:Tetralogy of Fallot / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha
keywords: cardiopulmonary bypass; congenital heart disease; cytokines; inflammatory response; outcomes