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

Abstract

BACKGROUND:

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.

• Authors: Massimo Caputo, Simon Bays, Chris A Rogers, Ash Pawade, Andrew J Parry, Saadeh Suleiman, Gianni D Angelini
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 80 Issue 3 Pg. 982-8 (Sep 2005) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 16122470 (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)