Cardiac Surgery with Deep Hypothermic Circulatory Arrest Produces Less Systemic Inflammatory Response

Objective:

We sought to compare low-flow cardiopulmonary bypass with deep hypothermic circulatory arrest in respect to the influence on the systemic inflammatory response.

Methods:

Twenty-three infants weighing less than 10 kg and scheduled for repair of congenital malformations were enrolled in a randomized, controlled study. Eleven patients underwent cardiac surgery with deep hypothermic circulatory arrest (the DHCA group). Low-flow cardiopulmonary bypass was used in another 12 patients (the LF group). Interleukin 6 and 8 and anaphylatoxin C3a levels were measured 6 times perioperatively. Also, perioperative weight gain and a radiologic soft-tissue index were compared.
Results:

All patients had an uneventful clinical course. Duration of deep hypothermic circulatory arrest was 40 ± 4 minutes; the bypass time was significantly shorter in the DHCA group (85 ± 8 vs 130 ± 19 minutes). However, the duration of the operation was similar in both groups (245 ± 30 vs 246 ± 30 minutes). During cardiopulmonary bypass (rewarming), the concentration of C3a (3751 ± 388 vs 5761 ± 1688 ng/mL, mean ± SEM) was significantly lower in the DHCA group than in the LF group. The interleukin 8 level was significantly lower, and the interleukin 6 level had a tendency to be lower in the DHCA group compared with levels in the LF group. There was less weight gain on the first postoperative day in the DHCA group (65 ± 61 vs 408 ± 118 g). The soft-tissue index suggested reduced edema formation in the DHCA group.
 

Conclusion:

Deep hypothermic circulatory arrest produces less systemic inflammatory response than low-flow cardiopulmonary bypass. In addition, there is an indication of less fluid accumulation postoperatively.

P. Tassani, MD^a,
A. Barankay, MD^a,
F. Haas, MD^b,
S. U. Paek, MD^b,
M. Heilmaier^a,
J. Hess, MD^c,
R. Lange, MD^b,
J. A. Richter, MD^a

From the Departments of Anesthesiology,^a Cardiovascular Surgery,^b and Pediatric Cardiology,^c Deutsches Herzzentrum München, München, Germany

Received for publication May 29, 2001. Revisions requested July 5, 2001; revisions received July 24, 2001. Accepted for publication Aug 31, 2001.

Address for reprints: Peter Tassani, MD, Department of Anesthesiology, Deutsches Herzzentrum München, Lazarettstr 36, 80636 München, Germany (E-mail: [email protected]).