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J Thorac Cardiovasc Surg 2002;123:648-654
© 2002 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Cardiac surgery with deep hypothermic circulatory arrest produces less systemic inflammatory response than low-flow cardiopulmonary bypass in newborns

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: tassani{at}dhm.mhn.de).

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.

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