Akademik Veri Yönetim Sistemi
Anesthesiology and Reanimation Specialists' Society Congress Balkan States Anesthesia Days-VII, 30 Nisan - 02 Mayıs 2021, ss.281
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.