Relationship Between Antiinflammatory Cytokine Interleukin-10 and Lactate Concentrations in Neonates Undergoing the Arterial Switch Operation.

BACKGROUND: The aim of this study was to evaluate the relationship between antiinflammatory cytokine interleukin (IL)-10 production and perioperative lactate concentrations and their impact on postoperative outcomes in neonates undergoing the arterial switch operation (ASO). METHODS: Between August 2010 and August 2012, 80 neonates with transposition of the great arteries (TGA) were enrolled. Serum IL-10 levels were measured immediately before and after cardiopulmonary bypass (CPB) on the first, third, and seventh days. Perioperative clinical data were collected prospectively. RESULTS: Patients underwent the ASO at a median age of 72 hours (4-144 hours). We found that serum IL-10 levels significantly correlated with a prolonged intensive care unit (ICU) length of stay (r = 0.3; p = 0.020) and duration of ventilation (r = 0.3; p = 0.017). Serum IL-10 levels on the first day after the surgical procedure had predictive value for a prolonged ICU stay (defined as an ICU stay >6 days postoperatively) by receiver operator curve analysis, with an area under the receiver operating characteristic (ROC) curve of 0.65 (p = 0.045). Logistic regression modeling indicated that serum lactate level (ß = 2.7; p = 0.027), age at operation (ß = -4.0; p = 0.007), and the nature (autologous or allogeneic) of blood products (ß = -3.5; p = 0.030) used during CPB affected serum IL-10 levels. The strongest predictor of increased IL-10 on the first day after operation was a serum lactate level greater than 3 mmol/L measured after the surgical procedure on admission to the ICU, recording an odds ratio of 15.31. Serum lactate levels after operation and at admission to the ICU positively correlated with a prolonged ICU stay (r = 0.4; p = 0.007). CONCLUSIONS: Elevated lactate levels are associated with increased IL-10 production on the first postoperative day. Excessive production of IL-10 on the first day after the surgical procedure is associated with a prolonged ICU stay.

Arterial switch operation in the first hours of life using autologous umbilical cord blood.

BACKGROUND: In this study, we analyzed our clinical experience performing the arterial switch operation in the first hours of life using autologous umbilical cord blood transfusion (AUCBT). The safety and efficiency of AUCBT was assessed and compared with surgery with the use of homologous blood transfusion. METHODS: Between September 2009 and February 2011, 61 neonates underwent ASO at our institution. Patients were enrolled and allocated to two groups with different modalities of management strategies for neonates with dextrotransposition of the great arteries. RESULTS: The groups were similar in diagnoses, birth weight, cardiopulmonary bypass protocol, and surgical technique, excepting timing of surgery and blood management strategy. Preoperative mean hematocrit did not differ significantly between the groups (45% versus 45%). Mean hematocrit was significantly lower in the study group than in the control group during cardiopulmonary bypass (24% versus 31%). The hematocrit progressively increased in the study group to 38% on the first postoperative day. Serum lactate levels were higher in the study group till the second day after surgery. There were no significant differences in postoperative clinical profiles. There were no hospital deaths and no AUCBT-related side effects in our study. CONCLUSIONS: The arterial switch operation can be performed in the first hours of life with AUCBT. Therefore, AUCBT is a safe and an efficient alternative to homologous blood in neonatal open heart surgery. During the study, we also identified positive economic effects associated with this approach.

Open cardiac surgery in the first hours of life using autologous umbilical cord blood.

OBJECTIVE: This article describes the first clinical experience of complete repair of complex critical congenital heart diseases (CHDs) in the first hours of life using autologous umbilical cord blood (UCB). Prenatal diagnosis and harvesting of autologous UCB allow to modify perioperative management and to perform corrective surgery in the first hours of a patient's life. This approach can afford avoiding homologous blood transfusion and preventing development of hypoxemia and heart failure due to hemodynamic changes of complex critical CHD. METHODS: The study group included 14 consecutive prenatally diagnosed patients with critical complex CHD during the period from September 2009 to August 2010. Autologous UCB was harvested in accordance to NetCord-FACT International Standards for Cord Blood Collection and was used during the surgery with cardiopulmonary bypass (CPB). In all cases, complete repair was performed during the first hours of life: arterial switch operation (n=9); arterial switch operation with total anomalous pulmonary venous communication repair (n=1); arterial switch operation with interruption of the aortic arch repair (n=1); Ebstein's repair (n=2); and aortopulmonary window repair with interruption of the aortic arch repair (n=1). All procedures were performed using moderate hypothermia with cold-crystalloid cardioplegia, except one case that required deep hypothermic circulatory arrest. RESULTS: A mean of 92±16 ml of UCB was harvested. Autologous UCB was used during the surgery in all 14 cases. Mean age of newborns at operation was 4.7±2 h (3-8). No patients required intensive care unit (ICU) admission, interventional procedures, mechanical ventilation, or medications before surgery. Twelve patients underwent bloodless open heart surgery; eight of them completely avoided homologous blood transfusion during the perioperative period. There was one postoperative death in our study (Ebstein's anomaly). CONCLUSIONS: The use of autologous umbilical cord blood is feasible in neonatal open heart surgery. Complete surgical repair of complex critical CHD can be applied successfully to neonates within the first hours of life.