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J Thorac Cardiovasc Surg 2002;124:991-998
© 2002 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Tumor necrosis factor and clinical and metabolic courses after cardiac surgery in children

Yokrat Sason-Ton, MDa, Ron Ben Abraham, MDb, Danny Lotan, MDa, Ovadia Dagan, MDa, Tal Prince, MDa, Zohar Barzilay, MD, FCCMa, Gideon Paret, MDa

From the Department of Pediatric Intensive Care, Chaim Sheba Medical Center, Tel Hashomer,a and the General Intensive Care Unit, Tel Aviv Sourasky Medical Center,b Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Received for publication June 19, 2001. Revisions requested Oct 1, 2001; revisions received Oct 29, 2001. Accepted for publication Dec 14, 2001. Address for reprints: Gideon Paret, MD, Department of Pediatric Intensive Care, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel (E-mail: gparet{at}netvision.net.il).

Objective: This study was undertaken to determine the relationship between plasma tumor necrosis factor concentrations and hemodynamic and metabolic parameters during the postoperative clinical course in children undergoing cardiac surgery.
Methods: Tumor necrosis factor levels of 10 consecutive children undergoing surgery for repair of congenital heart defects were analyzed in blood samples drawn at predetermined time points during surgery and up to 24 hours thereafter. Clinical data were collected at these times for correlation to tumor necrosis factor levels.
Results: All the patients survived. Tumor necrosis factor was detected in all 10 children. Tumor necrosis factor levels declined after induction of general anesthesia (201 ± 65 pg/mL) steadily decreasing during surgery, reaching 80 ± 50 pg/mL at 24 hours after the operation. Tumor necrosis factor levels were found to be inversely correlated with mean blood pressure values and indicators of acidosis (bicarbonate levels and base excess, P < .03). They were not correlated with the durations of cardiopulmonary bypass and aortic crossclamping.
Conclusions: Tumor necrosis factor released into the circulation during and after pediatric cardiac surgery under cardiopulmonary bypass may be related to the hemodynamic and acid-base changes observed after cardiac surgery. Elucidation of the relationship between tumor necrosis factor and patient outcome in high-risk patients awaits further studies.






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