Journal Article

Novel inflammatory mediator profile observed during pediatric heart surgery with cardiopulmonary bypass and continuous ultrafiltration

Henderson, Mark, Horne, David, Bierer, Joel, Andreou, Pantelis, Sett, Suvro, Sapp, John, Marshall, Jean S., Stanzel, Roger

2023

Overview

Background Cardiopulmonary bypass (CPB) is associated with systemic inflammation, featuring increased levels of circulating pro-inflammatory cytokines. Intra-operative ultrafiltration extracts fluid and inflammatory factors potentially dampening inflammation-related organ dysfunction and enhancing post-operative recovery. This study aimed to define the impact of continuous subzero-balance ultrafiltration (SBUF) on circulating levels of major inflammatory mediators. Methods Twenty pediatric patients undergoing cardiac surgery, CPB and SBUF were prospectively enrolled. Blood samples were collected prior to CPB initiation (Pre-CPB Plasma) and immediately before weaning off CPB (End-CPB Plasma). Ultrafiltrate effluent samples were also collected at the End-CPB time-point (End-CPB Effluent). The concentrations of thirty-nine inflammatory factors were assessed and sieving coefficients were calculated. Results A profound increase in inflammatory cytokines and activated complement products were noted in plasma following CBP. Twenty-two inflammatory mediators were detected in the ultrafiltrate effluent. Novel mediators removed by ultrafiltration included cytokines IL1-Ra, IL-2, IL-12, IL-17A, IL-33, TRAIL, GM-CSF, ET-1, and the chemokines CCL2, CCL3, CCL4, CXCL1, CXCL2 and CXCL10. Mediator extraction by SBUF was significantly associated with molecular mass < 66 kDa (Chi 2 statistic = 18.8, Chi 2 with Yates’ correction = 16.0, p < 0.0001). There was a moderate negative linear correlation between molecular mass and sieving coefficient (Spearman R = − 0.45 and p = 0.02). Notably, the anti-inflammatory cytokine IL-10 was not efficiently extracted by SBUF. Conclusions CPB is associated with a burden of circulating inflammatory mediators, and SBUF selectively extracts twenty of these pro-inflammatory factors while preserving the key anti-inflammatory regulator IL-10. Ultrafiltration could potentially function as an immunomodulatory therapy during pediatric cardiac surgery. Trial registration ClinicalTrials.gov, NCT05154864. Registered retrospectively on December 13, 2021. https://clinicaltrials.gov/ct2/show/record/NCT05154864 .

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Analysis / Biomedical and Life Sciences / Biomedicine / Cardiac patients / Cardiopulmonary bypass / Cardiovascular / Care and treatment / CCL4 protein / Chemokines / Chi-square test / Children / Complement / Congenital heart disease / Coronary artery bypass / Correlation analysis / CXCL10 protein / Cytokines / Effluents / Genetic disorders / Granulocyte-macrophage colony-stimulating factor / Health aspects / Heart / Heart surgery / Immunomodulation / Inflammation / Interleukin 10 / Interleukin 12 / Interleukin 2 / Medicine/Public Health / Metabolic and Lipoprotein Translation / Molecular weight / Monocyte chemoattractant protein 1 / Neutrophils / Patient outcomes / Patients / Pediatric cardiac surgery / Pediatric cardiology / Pediatrics / Plasma / Services / Thoracic surgery / Tumor necrosis factor-TNF / Ultrafiltration / Weaning