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Randomized comparison between normothermic and hypothermic cardiopulmonary bypass in pediatric open-heart surgery.

AbstractBACKGROUND:
The purpose of this study is to investigate the effect of cardiopulmonary bypass (CPB) temperature on myocardial reperfusion injury, oxidative stress, and inflammatory response in pediatric open heart surgery.
METHODS:
Fifty-nine children (median age 78 months; interquartile range, 39-130) undergoing correction of simple congenital heart defects were randomized to receive either hypothermic (28 degrees C) or normothermic (35-37 degrees C) CPB. Troponin I and 8-isoprostane, complement activation C3a, interleukin (IL) -6, -8, and -10, were measured preoperatively, on removal of the aortic cross clamp, 30 minutes, 6, and 24 hours postoperatively.
RESULTS:
Troponin I and 8-isoprostane were significantly raised, compared to baseline, in both groups, and remained high at 24 hours. Overall, troponin I and 8-isoprostane levels were 37% and 84% higher in the hypothermic than in the normothermic group, respectively (ratio 1.37, 95% CI 1.00 to 1.88, p = 0.053 and 1.84, 95% CI 1.22 to 2.78, p = 0.0045, respectively), and there was no evidence to suggest the treatment effect changed significantly over the time points measured (p = 0.63). Adjusting for aortic cross-clamp time reduced the effect of hypothermia on troponin (p = 0.18) but not on 8-isoprostane levels (p = 0.0028). The C3a, IL-6, and IL-8 release was similar in the two groups. The IL-10 release between the groups changed over time (p = 0.059) and examining differences at individual time points highlighted a statistically significant difference at the end of the cross-clamp time (p = 0.0079).
CONCLUSIONS:
Normothermic CPB is associated with reduced oxidative stress compared with hypothermic CPB, and similar myocardial reperfusion injury and whole body inflammatory response, in children undergoing open heart surgery. A larger study with clinical outcomes as primary end points is now warranted.
AuthorsMassimo Caputo, Simon Bays, Chris A Rogers, Ash Pawade, Andrew J Parry, Saadeh Suleiman, Gianni D Angelini
JournalThe Annals of thoracic surgery (Ann Thorac Surg) Vol. 80 Issue 3 Pg. 982-8 (Sep 2005) ISSN: 1552-6259 [Electronic] Netherlands
PMID16122470 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Biomarkers
  • Interleukins
  • Troponin I
  • 8-epi-prostaglandin F2alpha
  • Dinoprost
Topics
  • Biomarkers (metabolism)
  • Body Temperature
  • Cardiopulmonary Bypass (adverse effects, methods)
  • Child
  • Child, Preschool
  • Dinoprost (analogs & derivatives, blood)
  • Female
  • Heart Defects, Congenital (metabolism, surgery)
  • Humans
  • Hypothermia, Induced (adverse effects, methods)
  • Inflammation (etiology, metabolism)
  • Interleukins (metabolism)
  • Male
  • Myocardial Reperfusion Injury (etiology, metabolism)
  • Oxidative Stress
  • Pediatrics (methods)
  • Treatment Outcome
  • Troponin I (blood)

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