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Ann Thorac Surg 2003;75:919-925
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

Influence of two different perfusion systems on inflammatory response in pediatric heart surgery

^a Department of Pediatric Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
^b Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
^c Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden

Accepted for publication September 18, 2002.

^* Address reprint requests to Dr Jensen, Department of Pediatric Anesthesiology and Intensive Care, SU, Östra, S-41685 Gothenburg, Sweden.
e-mail: ev.jensen{at}telia.com

BACKGROUND: This study tests the hypothesis that a cardiopulmonary bypass system that combines complete heparin-coating, a centrifugal pump, and a closed circuit in comparison with a conventional system (uncoated system, roller pump, and hard shell venous reservoir) attenuates the inflammatory response in pediatric heart surgery.

METHODS: In a prospective randomized controlled clinical study 40 consecutive children weighing 10 kg or less were included and divided into two groups. Concentrations of complement proteins (C3a, sC5b-9, C4d, and Bb), granulocyte degranulation products (polymorphonuclear [PMN] elastase), and proinflammatory cytokines (tumor necrosis factor [TNF]-, interleukin [IL]-6, and IL-8) were measured.

RESULTS: C3a and sC5b-9 concentrations were lower (C3a, p < 0.001; sC5b-9, p = 0.01) in the combined (heparin-coated/centrifugal pump/closed reservoir) group, the peak values being 58% and 37% of conventional group values. The Bb- and C4d-fragment values indicated activation of the complement system through the alternative pathway in both groups. PMN elastase concentrations were lower (p = 0.02) in the combined group, the peak values being 43% of conventional group values. There were no significant intergroup differences regarding TNF-, IL-6, or IL-8 concentrations.

CONCLUSIONS: The use of a fully heparin-coated system, a centrifugal pump, and a closed circuit during CPB in children (10 kg or less) leads to a lower degree of complement activation and PMN elastase release compared with a conventional system.

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