Congenital heart disease (CHD) is a common birth defect that often requires surgical intervention. One significant postoperative complication is pulmonary arterial hypertension (PAH), which can lead to increased morbidity and prolonged recovery in pediatric patients. This study examines the impact of preoperative pulmonary artery systolic pressure (PASP) on postoperative inflammatory responses and early clinical outcomes in pediatric patients undergoing cardiopulmonary bypass (CPB).
Study Design and Methods
This retrospective observational study included 59 children under two years old who underwent surgical correction for CHD. The study divided the patients into two groups: those with PAH (n=34) and those without PAH (n=25). Researchers measured preoperative PASP via echocardiography and assessed postoperative inflammatory cytokines, including IL-6, IL-8, IL-10, IL-1β, and TNF-α, using blood samples taken before and two hours after CPB. Additionally, clinical outcomes such as postoperative ventilation time, intensive care unit (ICU) stay, and total hospital stay were recorded.
Key Findings
- Increased Inflammatory Cytokines: Following CPB, the levels of IL-6, IL-8, and IL-10 significantly increased in both PAH and non-PAH patients. However, the increase was more pronounced in the PAH group, suggesting that preoperative PAH contributes to a stronger systemic inflammatory response.
- Correlation Between PASP and Inflammatory Response: Preoperative PASP was positively correlated with postoperative IL-6 and IL-10 levels, indicating that higher pulmonary pressures may exacerbate inflammation after CPB. No significant association was found with IL-8.
- Prolonged Ventilation Time in PAH Patients: Patients with PAH had a significantly longer postoperative ventilation time (22.76 ± 2.49 hours) compared to non-PAH patients (13.72 ± 2.51 hours). Additionally, PAH patients had longer ICU and hospital stays.
- Predictive Value of PASP: A preoperative PASP greater than 52 mmHg was found to be a reliable predictor of prolonged postoperative ventilation (>21 hours). However, PASP did not significantly predict the length of ICU or total hospital stay.
Discussion and Implications
The study highlights the role of systemic inflammation in postoperative recovery in pediatric CHD patients. PAH exacerbates inflammatory responses, likely contributing to prolonged ventilation times and delayed recovery. IL-6 and IL-10, both key inflammatory markers, were significantly elevated in PAH patients, reinforcing the idea that inflammation plays a central role in adverse outcomes.
These findings suggest that preoperative PASP could be used as a prognostic marker to identify high-risk patients. Interventions aimed at managing inflammation, such as targeted anti-inflammatory therapies or optimized perioperative management, may improve outcomes for PAH-CHD patients undergoing CPB.
Conclusion
This study underscores the importance of preoperative PASP in predicting postoperative inflammatory responses and clinical outcomes. Elevated PASP correlates with higher levels of IL-6 and IL-10, leading to longer mechanical ventilation and ICU stays. Future research should explore strategies to mitigate inflammation in high-risk pediatric patients to improve postoperative recovery and reduce complications.
Study Ranking = 5 (Highest Quality)
- Strengths: Well-designed observational study with clear methodology and strong statistical correlations.
- Limitations: Retrospective design and small sample size. Further large-scale prospective studies are needed.
