Abstract 2796: Preoperative Inflammatory State Correlates with Postoperative Outcomes following Infant Cardiac Surgery
Introduction: Cardiopulmonary bypass (CPB) induces a systemic inflammatory response. The magnitude and consequences in infants remain unclear.
Hypothesis: We hypothesized that a subset of infants has significant inflammatory activation preoperatively, and that this is an important determinant of postoperative outcomes.
Methods: Concentrations of 29 cytokines (protein microarray, Zyomix), including IL-6, IL-8, and IL-10, as well as CRP (high-sensitivity ELISA) were measured pre-CPB, immediately post-CPB, and at 6, 12, and 24 hr post-CPB in infants ≤ 9 months old. Defined pre-, intra-, and post-operative data were also collected. The relationship between inflammatory mediators and clinical variables was assessed using Spearman correlation coefficients
Results: Ninety-two patients were enrolled. Diagnoses included TGA (39), TOF (28), VSD (21), truncus arteriosus (2), and CAVC (2). Median age was 38 d (2 - 264 d), median weight 4.3 kg (2.4 − 7.3 kg). IL−6 increased immediately post-CPB (12 ± 27 vs 45 ± 70 pg /ml) and at 6 (180 ±324 pg/mL), 12 (177 ± 233 pg/mL), and 24 hrs (148 ± 278 pg/mL) (p<.0001). CRP increased post-CPB, peaking at 24 hrs (1.7 ±3.3 mg/L vs 28.4 ± 16.0 mg/L, p < .001). IL-10 and IL-8 also increased immediately post-CPB. Both IL-6 and CRP were significantly higher preop in younger infants. Plasma lactate (12 and 24 hrs post-CPB), 24 hr PRISM III scores, and the length of intubation, ICU, and hospital stay were strongly associated with increased preop IL-6 and CRP.(Table 1⇓). Similarly, pre-op IL-8 correlated inversely with age and positively with length of ICU and hospital stay.
Conclusions: The presence of a preoperative inflammatory state strongly correlates with postoperative outcome; the magnitude is greatest in the youngest patients. Identifying these patients and the underlying mechanism(s) may direct use of targeted therapies to reduce the morbidity of CPB in these patients.