SYSTEMIC INFLAMMATORY RESPONSE SYNDROME IN CYANOTIC AND ACYANOTIC CHILDREN UNDERGOING AFTER CONGENITAL HEART SURGERY


Karacaer F. , Biricik E. , Ilgınel M. T. , Tunay D. L. , Berk N., Güzel Y.

Anesthesiology and Reanimation Specialists' Society Congress Balkan States Anesthesia Days-VII, 30 April - 02 May 2021, pp.281

  • Publication Type: Conference Paper / Summary Text
  • Page Numbers: pp.281

Abstract

Background and Goal of Study / Background: Cardiac surgery with cardiopulmonary bypass

(CPB) is a primary activator of the systemic inflammatory response syndrome (SIRS) that is

considered a major contributor to postoperative complications1. In this study, we aimed to

compare the incidence of postoperative SIRS after cardiac surgery between cyanotic and

acyanotic children and to assess the association of postoperative SIRS with intraoperative

variables and early postoperative outcomes.

Materials and Methods: The children aged 2 months-16 years, undergoing cardiac surgery

with CPB for cyanotic or acyanotic congenital heart disease, were included in this prospective,

observational, cohort study. Perioperative clinical data were recorded. The presence of SIRS

for each patient was evaluated based on the International Pediatric Sepsis Consensus

Conference. The SIRS occurence was evaluated at the end of the operation and at 6, 24 and

48 hours postoperatively.

Results and Discussion / Discussion: Of 197 children (median age: 26 months [2 months-16

years]) included in the study, 83 were cyanotic and 114 were acyanotic and SIRS occured in

117 (59,4%) patients. The patients in the SIRS group were older than no-SIRS group (p<0,001).

The SIRS incidence was not statistically different between cyanotic and acyanotic children

(p=0,427). Aortic cross clamp time was longer and the quantity of administered crystalloid

fluid and fresh frozen plasma (FFP) intraoperatively was higher in children with SIRS (p=0,042,

p<0,001, p=0,005). The lactate levels at the 6th and 48th hours postoperatively was higher in

the SIRS group (p=0,012, p=0,032). The mortality rate was higher in the cyanotic children

(p=0,03). In this study, the incidence of SIRS was 59,4% following congenital heart surgery.

While in previous studies, lower weight, younger age and longer CPB time have been identified

as risk factors for SIRS occurence2,3, in our study we identified older age, aortic cross clamp

time and quantity of administered FFP and crystalloid fluid as risk factors. Cyanosis was not a

risk factor in this study. As the coagulation and inflammatory system are closely linked in

multiple ways, FFP might contribute to the SIRS3.

Conclusion(s): The incidence of SIRS after congenital cardiac surgery was higher in our study

than previous studies and perioperative FFP exposure may increase the inflammatory

response.