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Cardiopulmonary bypass (CPB) elicits a systemic inflammatory response. The neutrophil elastase inhibitor sivelestat is known to suppress this systemic inflammatory response, which can eventually result in acute organ failure. The prophylactic effect of sivelestat on acute lung injury, especially in pediatric cardiac surgery, remains unclear. This prospective double-blind, randomized study evaluated the perioperative prophylactic effect of sivelestat in patients undergoing elective pediatric open heart surgery with CPB. Thirty consecutive patients, weighing 5-10 kg and undergoing open heart surgery with CPB, were assigned to sivelestat (n = 15) or control (n = 15) groups. From CPB initiation to 24 h after surgery, patients in the sivelestat group received a continuous intravenous infusion of 0.2 mg/kg/h sivelestat, whereas patients in the control group received the same volume of 0.9% saline. Blood samples were collected, and levels of interleukin (IL)-6, IL-8, tumor necrosis factor alpha, polymorphonuclear elastase (PMN-E), C-reactive protein (CRP), as well as the white blood cell (WBC) count, platelet count, and neutrophil count (NC) were measured. PMN-E levels, IL-8 levels, WBC count, NC, and CRP levels were significantly lower, and platelet count was significantly higher in the sivelestat group, according to repeated two-way analysis of variance. The activated coagulation time was significantly shorter in the sivelestat group, similarly, blood loss was significantly less in the sivelestat group. In conclusion, Sivelestat attenuates perioperative inflammatory response and clinical outcomes in patients undergoing pediatric heart surgery with CPB., (© 2013 Wiley Periodicals, Inc. and International Center for Artificial Organs and Transplantation.)

Aim: We conducted a retrospective analysis of 35 patients with various congenital heart defects who underwent pulmonary artery banding (PAB) between January 2018 and September 2023. Our objective was to evaluate the outcomes of PAB and discuss its application in a staged approach for these patients. Material and Methods: The median age at PAB was 5 months (range: 2 to 20 months) with a median weight of 5.2 kg (range: 3 to 9 kg). Results: The hospital and total mortality rates were 11.4% (4). The median intensive care unit stay was 2 days (range: 1 to 22 days), and the median hospital stay was 5 days (range: 5 to 36 days). The second stage (either total correction or cavapulmonary anastomosis) was achieved in 40% (14/35) of patients at a median age of 15 months. The mean interval to repair was 8 months, with 12 out of 14 patients undergoing complete biventricular repair. Conclusion: Our study demonstrates that PAB could be performed with acceptable outcomes, serving as a viable palliative measure for neonates and extremely small infants who are at high risk for cardiopulmonary bypass. Our study results exhibit a comparable trend to previously reported findings, emphasizing the importance of PAB in managing congenital heart malformations characterized by increased pulmonary blood flow. While the effectiveness of PAB has been validated in our study, future investigations could delve into refining surgical protocols, optimizing band adjustment techniques, and exploring potential preventive measures for common postoperative complications. [ABSTRACT FROM AUTHOR]

Stress caused by cardioplegic ischemic arrest was shown to alter the expression levels of heat shock proteins (Hsp), but little is known about their effects, particularly on pediatric hearts. This study aimed to investigate whether myocardial cellular stress and apoptotic response changes due to different cardioplegia (CP) solutions during cardiopulmonary bypass (CPB) in infants and to determine their influence on surgical/clinical outcomes. Therefore, twenty-seven infants for surgical closure of ventricular septal defect were randomly assigned to a CP solution: normothermic blood (BCP), delNido (dNCP), and Custodiol (CCP). Hsp levels and apoptosis were determined by immunoblotting in cardiac tissue from the right atrium before and after CP, and their correlations with cardiac parameters were evaluated. No significant change was observed in Hsp27 levels. Hsp60, Hsp70, and Hsp90 levels decreased significantly in the BCP-group but increased markedly in the CCP-group. Decreased Hsp60 and increased Hsp70 expression were detected in dNCP-group. Importantly, apoptosis was not observed in dNCP- and CCP-groups, whereas marked increases in cleaved caspase-3 and -8 were determined after BCP. Serum cardiac troponin-I (cTn-I), myocardial injury marker, was markedly lower in the BCP- and dNCP-groups than CCP. Additionally, Hsp60, Hsp70, and Hsp90 levels were positively correlated with aortic cross-clamp time, total perfusion time, and cTn-I release. Our findings show that dNCP provides the most effective myocardial preservation in pediatric open-heart surgery and indicate that an increase in Hsp70 expression may be associated with a cardioprotective effect, while an increase in Hsp60 and Hsp90 levels may be an indicator of myocardial damage during CPB. [ABSTRACT FROM AUTHOR]

In this study, we aimed to evaluate the effects of thyroid hormone levels on the prognosis of patients who underwent congenital heart surgery under cardiopulmonary bypass. A total of 40 children who underwent congenital heart surgery were enrolled to this prospective study. The patients were divided into two groups according to the presence or absence of postoperative low cardiac output state. Plasma free thyroxine, free triiodothyronine and thyroid stimulating hormone levels were measured preoperatively and at 24 and 48 hours postoperatively. Postoperative low cardiac output state was observed in five patients (12.5 %). Preoperative free thyroxine levels were significantly higher in the low cardiac output state group (p=0.021). Postoperative free triiodothyronine and free thyroxine levels were significantly lower, and lactate levels, inotropic index were significantly higher in the low cardiac output state group. Duration of mechanical ventilation, intensive care unit stay, operation and cardiopulmonary bypass were significantly higher in the low cardiac output state group. Four patients (10 %) died in the early postoperative period, and all of them were in the low cardiac output state group. Our findings showed that the occurrence of low cardiac output state after congenital heart surgery was associated with the high levels of preoperative free thyroxine and the reduction in percentage of free triiodothyronine and free thyroxine levels at the 24th and 48th hours postoperatively. [Med-Science 2019; 8(2.000): 395-400]

Objectives: In the previous study we demonstrated that normothermic cardiopulmonary bypass (N-CPB, ≥35°C) provided better early clinical outcomes compared to mild/moderate hypothermic cardiopulmonary bypass (H-CPB, 28–34°C) for congenital heart surgery. In this follow-up study we compare early neurodevelopmental outcomes 2–3 years post-surgery.Methods: In this retrospective, non-randomized observational study, the medical notes of children from our previous cohort were reviewed after 2–3 years. Demographic and neurodevelopmental outcomes were tabulated to enable blinded statistical analysis comparing outcomes between N-CPB and H-CPB surgery for congenital heart defects. Multivariate logistic regression models were developed to identify any differences in outcomes after adjustment for confounders.Results: Ninety-five children who underwent H-CPB (n = 50) or N-CPB (n = 45) were included. The proportions of patients with one or more adverse neurodevelopmental outcomes 2–3 years later were 14/50 (28.0%) in the H-CPB group and 11/45 (24.4%) in N-CPB, which was not significantly different between groups (p = 0.47). The two CPB groups were balanced for demographic and surgical risk factors, with the exception of genetic conditions. A higher incidence of H-CPB patients acquired learning difficulties [23.1% compared to 2.56% for N-CPB (p = 0.014)] and neurological deficits [30.8% compared to 7.69% for N-CPB (p = 0.019)], but these differences were not robust to adjustment for genetic syndromes.Conclusions: Our study did not reveal any significant differences in early neurodevelopmental outcomes between H-CPB or N-CPB surgery for congenital heart defects. The most important factor in predicting outcomes was, as expected, the presence of a genetic syndrome. We found no evidence that CPB temperature affects early neurodevelopmental outcomes.

Objective: Transfusion of blood and blood products may be unavoidable in pediatric patients undergoing cardiac surgery. The aim of this study was to determine the factors and risks associated with transfusion of blood and blood products in these patients. Method: Preoperative demographic data, cardiopulmonary bypass (CPB) and operation times were recorded. Hematocrit and hemoglobin values were recorded at the beginning, during and at the end of CPB. The lowest body temperature during CPB, intraoperative consumptions of crystalloid, colloid, blood, blood products were recorded. The consumption of blood and blood products, length of stay intensive care unit (ICU) and hospital, and mortality were recorded during the postoperative period. Results: Eighty-three children were included in the study. Intraoperative transfusion of erythrocyte suspension (ES) was more frequently applied in patients with RACHS1: 3 when compared with the patients with RACHS1: 2 (p=0.009). A negative correlation was detected between age and postoperative ES, total erythrocyte and total fresh frozen plasma (FFP) transfusions during intraoperative, and postoperative periods. A a positive correlation was determined between CPB duration and intraoperative erythrocyte and FFP, postoperative erythrocyte, FFP, cryoprecipitate, total erythrocyte and total FFP consumptions. The intraoperative ES and FFP consumptions, the postoperative cryoprecipitate consumptions were higher in cyanotic children (ES p=0.002; FFP p=0.002, cryoprecipitate p=0.026) when compared with acyanotic children. Fifteen patients died. Postoperative ES and FFP, total erythrocyte and FFP consumptions were higher in the deceased patients (total ES p=0.001, total FFP p=0.003). Conclusion: A correlation was detected between intraoperative, and postoperative transfusion rates, age, RACHS1 scores, body temperatures of the patients, duration of CPB, and presence of cyanosis in children undergoing open heart surgery. Higher rates of ES and FFP transfusions were detected in exited patients. [ABSTRACT FROM AUTHOR]

Objective: In the tetralogy of Fallot, a wide spectrum of cardiac anomalies, dynamic physiological changes including the effects of anesthetic agents, type of surgical intervention (palliative intervention or correction operation) to be performed and non-cardiac malformations complicate intraoperative management. In this retrospective study, we aimed to evaluate perioperative anesthesia management in 40 pediatric patients undergoing tetralogy of Fallot surgery in our hospital. Method: Forty patients who underwent tetralogy of Fallot surgery between October 2016-September 2018 in our hospital were evaluated retrospectively. Results: Twenty-five patients were cyanotic and 15 patients were acyanotic. There was no statistically significant difference between these patients in terms of cardiopulmonary bypass, crossclamping and operation time and consumption of fluid, transfusion of blood and blood products. Any difference between patients as for postoperative extubation time, intensive care unit, and hospital stay times. Similarly, patients with and without multiple aortopulmonary collaterals were compared and no statistically significant difference was found between them. Hypercyanotic spell attack was observed in 6 patients during anesthesia induction, and 3 patients died during the postoperative period. Conclusion: Preoperative cardiac anomaly should be defined when planning cardiac repair operations of tetralogy of Fallot patients. Appropriate anesthesia, surgery and cardiopulmonary bypass management should be provided by taking into consideration the intraoperative anesthesia management, the comorbidities and the prevalent post-operative problems in the intensive care unit. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal membrane oxygenation (ECMO) is used in a variety of indications worldwide. One of the most important subsets is postoperative congenital cardiac surgery cases unresponsive to conventional therapies. In this study, we present our ECMO experience in a single congenital cardiac surgery center. Methods: ECMO was used in a total of 34 postoperative congenital cardiac surgery cases, whose operations had been performed by the same congenital cardiac surgery team. Patients’ ages were between 3 days to 15 years. ECMO was used in four different indications; in case of unsuccessful weaning from cardiopulmonary bypass (OR-ECMO), in low cardiac output syndrome (LCOS-ECMO), in refractory post cardiac arrest (CPR-ECMO) and in respiratory insufficiency after RSV infection (RSV-ECMO). Results: The follow-up period of patients ranged from 1 to 80 months, whereas ECMO duration ranged from 23 to 2218 hours. Six cases were OR-ECMO, 13 were LCOS-ECMO, 12 were CPR-ECMO and 3 were RSV-ECMO. Out of a total of 34 cases, 20 (58%) cases were weaned from ECMO. Two of the patients, who were able to be weaned from ECMO passed away in the hospital; however, the other 18 patients (52.9%) were discharged from the hospital without having any significant neurological deficits. The top survival rate (69%) and weaning from ECMO was in the LCOS-ECMO group and the worst weaning from ECMO support (33%) was in the RSV-ECMO. The worst survival rate (25%) was in the CPR-ECMO group. Sepsis and associated multiple organ dysfunction were observed as the major cause of mortality in these patients. The most common complications were bleeding and mechanical complications related to cannulation. Conclusions: ECMO may be required in postoperative congenital cardiac surgery cases in whom all other conventional therapies have failed. Indications, timing and maintenance of equipment are very important points in successful ECMO management. Increasing ECMO experience in the near future, will provide much decrease in mortality of congenital cardiac surgery. [ABSTRACT FROM AUTHOR]

Se realizó un estudio de casos y controles de 121 niños intervenidos por cirugía cardíaca con circulación extracorpórea en el Cardiocentro de Santiago de Cuba (de 336 en total), en el período 1987- 2004, a fin de identificar los factores asociados que influyeron en la aparición de complicaciones neurológicas graves (en 11 de los catalogados como casos), entre los cuales figuraron: tipo de cardiopatía (adquirida) y tiempo total de perfusión (prolongado); los escogidos como controles, no complicados, sumaron 110. Desde el punto de vista significativo se consideraron importantes las variables: complejidad de la operación, tiempo de paro anóxico y temperatura utilizada en la circulación extracorpórea, cuya presencia, tanto aisladas como asociadas, debe alertar al equipo médico sobre la posible ocurrencia de dichas complicaciones. Este estudio es el primero de su tipo efectuado en Cuba.A case-control study was carried out in 121 children who underwent heart surgery with cardiopulmonary bypass at the Cardiology Center of Santiago de Cuba (of 336 total), in the period 1987 - 2004, in order to identify associated factors that influenced the occurrence of serious neurological complications (in 11 of those identified as cases), among which were: type of heart disease (acquired) and total time of perfusion (prolonged). Those chosen as controls without complications added up to 110. The following variables were considered statistically significant: complexity of the operation, time of anoxic arrest and temperature used in cardiopulmonary bypass. The presence of both isolated and associated variables should alert the medical team to the possible occurrence of such complications. This study is the first of its kind made in Cuba.

Plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels increase after cardiopulmonary bypass (CPB) in pediatric patients. However, the exact reason for the postoperative increase remains unclear. This study elucidated the perioperative changes in plasma natriuretic peptide levels in children undergoing surgical isolated atrial septal defect (ASD) closure. Between 2010 and 2012, 24 pediatric patients (median 7.1, range 2.7-15.7 years) underwent surgery for simple ASD using CPB under ventricular fibrillation (Group A, 16 patients) or under cardiac arrest (Group B, 8 patients). Natriuretic peptide levels were measured before surgery, on postoperative day 0, 1, 3, and at the first outpatient visit. The pulmonary to systemic blood flow ratio (Qp/Qs) was estimated by echocardiography using an index of right ventricle end-diastolic area. Preoperative natriuretic peptide levels positively correlated with the Qp/Qs. Plasma ANP levels peaked on postoperative day 0, and its values were higher in Group A than in Group B patients ( p < 0.001). Plasma BNP levels increased significantly in both Groups on postoperative day 1, and its values were significantly greater in Group A than in Group B patients ( p = 0.007). There was a weak negative correlation between the amount of postoperative increase in natriuretic peptide levels and the Qp/Qs. There was no appreciable difference in the acute postoperative clinical course and echocardiographic parameter on postoperative day 3 between Group A and B patients. In conclusion, acute postoperative natriuretic peptide levels after isolated ASD closure were multifactorial, and they might be unreliable for predicting clinical outcomes. [ABSTRACT FROM AUTHOR]

Until recently, risk scoring systems for adult patients consisted of only clinical criteria. Currently, we are experiencing an abundant surge of literature integrating a wide range of biomarker arrays to clinical criteria in assessing the risk in an adult. In fact, novel risk scoring systems such as Reynolds criteria have emerged by combining the validated biomarkers to the traditional risk factors. Novel biomarkers potentially improve clinical management of cardiovascular disease, but there are gaps in understanding their role during childhood. The reason might be related to relatively lower prevalence of cardiovascular disease in children compared to the adult population. One exceptional group is the children with congenital heart disease. Recent studies indicate that novel biomarkers can alert the clinician in a timely manner about neurological and myocardial injury and their inflammatory consequences. Current technologies enable us to measure several biomarkers using only a few microliters of plasma. The preliminary studies show that novel biomarkers in addition to the traditionally studied biomarkers can help the clinician to identify children at high risk following pediatric heart surgery. Future studies are needed to confirm the role of biomarkers in monitoring children after cardiopulmonary bypass. [ABSTRACT FROM AUTHOR]

Objective: To evaluate procalcitonin and C-reactive protein as markers of inflammation severity and their value in predicting development of organ failure after pediatric open heart surgery.Design: Prospective, observational, clinical study.Setting: Single university hospital.Patients: Thirty-three pediatric patients with systemic inflammatory response syndrome (SIRS; n=19) and SIRS+organ failure (SIRS+OF; n=14) following open heart surgery were included.Measurements and Results: Plasma procalcitonin and C-reactive protein levels were measured before and after the operation, and 1, 2, 3, and 4 days after surgery. Patients were evaluated daily to assess organ failure. Postoperative procalcitonin levels in the SIRS+OF group were significantly higher than in the SIRS group. C-reactive protein levels were similar between the groups throughout the study period. Peak procalcitonin levels were found to be positively correlated with aortic cross-clamp and cardiopulmonary bypass times, duration of mechanical ventilation, intensive care unit and hospital stay, mortality and organ failure development. Peak procalcitonin was found to be a good predictor of postoperative organ failure development and mortality. However, the predictive value of peak C-reactive protein for organ failure and mortality was found to be weak. Double-peak procalcitonin curves were observed in SIRS+OF patients with infection during the intensive care unit stay.Conclusion: In the SIRS+OF group peak procalcitonin levels were found to be highly predictive for mortality and organ failure development, whereas C-reactive protein levels were not. Daily procalcitonin measurements in SIRS+OF patients may help identify the postoperative infection during the follow-up period. [ABSTRACT FROM AUTHOR]