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J Thorac Cardiovasc Surg 2005;130:54-60
© 2005 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Monocyte function-associated antigen expression during and after pediatric cardiac surgery

Peter Gessler, MD a , * , Rene Pretre, MD b , Christoph Bürki, MD c , Valentin Rousson e , Bernhard Frey, MD a , David Nadal, MD d

a Division of Pediatric Intensive Care Medicine, University Children’s Hospital of Zurich, Zurich, Switzerland
b Division of Cardiovascular Surgery, University Children’s Hospital of Zurich, Zurich, Switzerland
c Division of Anesthesiology, University Children’s Hospital of Zurich, Zurich, Switzerland
d Division of Infectious Diseases, University Children’s Hospital of Zurich, Zurich, Switzerland
e Department of Biostatistics, University of Zurich, Zurich, Switzerland

Received for publication November 4, 2004; revisions received December 17, 2004; accepted for publication January 10, 2005.

* Address for reprints: Peter Gessler, MD, University Children’s Hospital, Steinwiesstr 75, CH 8032 Zurich, Switzerland (Email: peter.gessler{at}kispi.unizh.ch).

OBJECTIVE: Systemic inflammatory response syndrome and infectious complications are major causes of morbidity and mortality after cardiopulmonary bypass. Recent work in adult patients suggests that the balance between proinflammatory and anti-inflammatory mediators is important. We hypothesized that the expression of different function-related receptors on circulating monocytes might reflect the net response of the inflammatory reaction.

METHODS: We performed a prospective and observational study in a tertiary pediatric cardiac center in a population of children (n = 40) undergoing elective cardiac surgery. Expression of receptors on the surface of monocytes was assessed before, during, and after surgical intervention.

RESULTS: Early monocyte activation was demonstrated by changes of the expression of the chemokine receptor CCR2, which was inversely correlated with plasma levels of monocyte chemotactic protein 1 (rho = –0.54, P = .002). High levels of monocyte chemotactic protein 1 were found in children with high expression of the adhesion receptor CD11b/CD18 on circulating monocytes. The intensity of human leukocyte antigen DR expression rapidly decreased in all children after the onset of cardiopulmonary bypass (P < .001). Low human leukocyte antigen DR expression was correlated with increased plasma levels of interleukin 10 postoperatively. Children who had signs of bacterial pneumonia postoperatively had lower levels of human leukocyte antigen DR expression before surgical intervention (relative risk, 13.3; P = .007).

CONCLUSIONS: The expression of monocyte function-related receptors is altered after cardiac surgery. Early activation of monocytes by monocyte chemotactic protein 1 possibly released from the heart is followed by an anti-inflammatory response with suppression of monocyte human leukocyte antigen DR expression. The increased risk of bacterial infection after pediatric cardiac surgery can be anticipated by surveillance of monocyte function before surgical intervention.




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A. Franke, W. Lante, L. G. Zoeller, E. Kurig, C. Weinhold, and A. Markewitz
Delayed recovery of human leukocyte antigen-DR expression after cardiac surgery with early non-lethal postoperative complications: only an epiphenomenon?
Interactive CardioVascular and Thoracic Surgery, April 1, 2008; 7(2): 207 - 211.
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