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Original Articles: Cardiovascular

Effect of Perfusion Temperature on the Inflammatory Response During Pediatric Cardiac Surgery

^a Department of Thoracic and Cardiovascular Surgery, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Oslo, Norway
^b Research Institute for Internal Medicine, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Oslo, Norway
^c Institute of Immunology, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Oslo, Norway
^d Section of Clinical Immunology and Infectious Diseases, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Oslo, Norway
^e Department of Vascular Surgery, Buskerud Hospital, Drammen, Norway
^f Institute of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, and Department of Immunology and Transfusion Medicine, St. Olav University Hospital, Trondheim, Norway

Accepted for publication October 17, 2007.

^_* Address correspondence to Dr Eggum, Department of Vascular Surgery, Buskerud Hospital, Drammen, N-3004, Norway (Email: rune.eggum{at}sb-hf.no).

Background: Cardiopulmonary bypass (CPB) triggers the whole body inflammatory response, and it has been suggested that the degree of hypothermia may influence these responses. The aim of this prospective study was to compare the inflammatory response in children undergoing CPB for repair of congenital heart defects, randomized to mild or moderate hypothermia.

Methods: We measured inflammatory markers in blood samples of thirty children with body weight less than 10 kg undergoing open heart surgery randomized to surgery at either mild (32°C) or moderate (25°C) hypothermia. Blood was sampled after induction of anesthesia, at skin closure, 2 hours, 24 hours, and 48 hours postoperatively.

Results: Except for an enhanced interleukin-8 response in the moderate hypothermia group, there were no differences in levels of inflammatory mediators between those with mild and those with moderate hypothermia. In contrast to the modest influence of the degree of hypothermia, long CPB time and long aortic cross-clamp time were accompanied by enhanced inflammation involving raised levels of interleukin-8 and myeloperoxidase, as well as increased leukocyte counts.

Conclusions: Only minor differences in cytokine levels were detected between those with moderate and those with mild hypothermia during CPB. Ischemic aortic cross-clamp time and time on CBP should be as short as possible to avoid an excessive inflammatory response and possibly adverse clinical effects.

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