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J Thorac Cardiovasc Surg 2009;138:1172-1179
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

Preoperative lymphopenia is a predictor of postoperative adverse outcomes in children with congenital heart disease

^a Department of Pediatrics, University of Tennessee, Memphis/Le Bonheur Children's Medical Center, Memphis, Tenn
^b Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Ark
^c Department of Surgery, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Ark

Received for publication November 25, 2008; revisions received April 3, 2009; accepted for publication June 14, 2009.

^_* Address for reprints: Adnan T. Bhutta, MBBS, FAAP, Assistant Professor, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512, Little Rock, AR 72202. (Email: bhuttaadnant{at}uams.edu).

Objective: Lymphopenia is a predictor of adverse clinical outcomes in adults with various systemic diseases. We hypothesized that preoperative absolute lymphopenia (absolute lymphocyte count of less than 3000 cells/µL) is associated with adverse postoperative outcomes in children with congenital heart disease undergoing corrective or palliative surgery on cardiopulmonary bypass during the first 2 years of life.

Methods: A retrospective single center cohort study was performed. Categorical variables were analyzed with the ² test. Preoperative variables were analyzed with logistic and linear regression analysis to determine whether they were associated with adverse outcomes.

Results: Analysis was performed on 280 patients, of whom 124 were female and 156 were male. Seventy-one patients were neonates (30 days) at the time of the operation. Ninety patients had an absolute lymphocyte count of less than 3000 cells/µL before the operation. Regression models showed that RACHS-1 categories 5 and 6, age, and preoperative lymphopenia were significantly associated with postoperative mortality (P < .0006). Within RACHS-1 groups, lymphopenia remained a significant predictor of mortality for patients in RACHS categories 3 and 4. Lymphopenia and age were associated with longer length of stay and length of mechanical ventilation within RACHS categories 1 to 4 (P < .05). Preoperative lymphopenia was the only predictor of use of postoperative nitric oxide (P < .05).

Conclusions: Preoperative lymphopenia is a predictor of adverse postoperative outcomes in children with congenital heart disease who undergo a corrective or palliative procedure with cardiopulmonary bypass during the first 2 years of life.