Cardiac surgery with deep hypothermic circulatory arrest produces less systemic inflammatory response than low-flow cardiopulmonary bypass in newborns

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 123; no. 4; pp. 648 - 654
• Main Authors: Tassani, P., Barankay, A., Haas, F., Paek, S.U., Heilmaier, M., Hess, J., Lange, R., Richter, J.A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2002; AATS/WTSA
• Subjects: Blood Pressure - drug effects; Body Weight - physiology; Cardiopulmonary Bypass; Cardiotonic Agents - therapeutic use; Complement Activation; Complement C3a - immunology; Complement C3a - metabolism; Dobutamine - therapeutic use; Dopamine - therapeutic use; Heart Arrest, Induced; Heart Defects, Congenital - blood; Heart Defects, Congenital - complications; Heart Defects, Congenital - surgery; Heart Rate - drug effects; Humans; Hypothermia, Induced; Infant; Infant Welfare; Inflammation Mediators - blood; Interleukin-6 - blood; Interleukin-8 - blood; Postoperative Complications - blood; Postoperative Complications - etiology; Systemic Inflammatory Response Syndrome - blood; Systemic Inflammatory Response Syndrome - etiology; Time Factors; Treatment Outcome
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1067/mtc.2002.121285

Objective: We sought to compare low-flow cardiopulmonary bypass with deep hypothermic circulatory arrest in respect to the influence on the systemic inflammatory response. Methods: Twenty-three infants weighing less than 10 kg and scheduled for repair of congenital malformations were enrolled in a randomized, controlled study. Eleven patients underwent cardiac surgery with deep hypothermic circulatory arrest (the DHCA group). Low-flow cardiopulmonary bypass was used in another 12 patients (the LF group). Interleukin 6 and 8 and anaphylatoxin C3a levels were measured 6 times perioperatively. Also, perioperative weight gain and a radiologic soft-tissue index were compared. Results: All patients had an uneventful clinical course. Duration of deep hypothermic circulatory arrest was 40 ± 4 minutes; the bypass time was significantly shorter in the DHCA group (85 ± 8 vs 130 ± 19 minutes). However, the duration of the operation was similar in both groups (245 ± 30 vs 246 ± 30 minutes). During cardiopulmonary bypass (rewarming), the concentration of C3a (3751 ± 388 vs 5761 ± 1688 ng/mL, mean ± SEM) was significantly lower in the DHCA group than in the LF group. The interleukin 8 level was significantly lower, and the interleukin 6 level had a tendency to be lower in the DHCA group compared with levels in the LF group. There was less weight gain on the first postoperative day in the DHCA group (65 ± 61 vs 408 ± 118 g). The soft-tissue index suggested reduced edema formation in the DHCA group. Conclusion: Deep hypothermic circulatory arrest produces less systemic inflammatory response than low-flow cardiopulmonary bypass. In addition, there is an indication of less fluid accumulation postoperatively.
J Thorac Cardiovasc Surg 2002;123:648-54