Inflammatory marker levels after hybrid treatment of selected congenital heart disease in children.

BACKGROUND

Hybrid treatment of congenital heart disease is indicated in a selected group of borderline patients who do not have clear indications for either surgery or interventional treatment. Hybrid procedures take the best from cardiac surgery and interventional cardiology to reduce patient risk and trauma. Hybrid closure of ventricular septal defect (VSD) and atrial septal defect (ASD) without the use of extracorporeal circulation (ECC) might be less traumatic for patient.

AIM: To compare levels of inflammatory markers and clinical symptoms of systemic inflammatory response syndrome during early postoperative care after conventional cardiac surgery and hybrid treatment.

METHODS

Our study group of 36 paediatric cardiac surgical patients in Gdansk included 22 children with perimembraneous VSD and/or ASD who underwent cardiac surgery using with ECC and 12 children with muscular VSD and 2 children with ASD who underwent hybrid treatment. We retrospectively evaluated inflammatory markers including C-reactive protein (CRP) level, white blood cell (WBC) count and mean platelet volume (MPV), and clinical variables including total duration of stay in the ward, blood transfusions, prolonged respiratory support, fever, arrhythmias, catecholamine support and wound infections. The Mann-Whitney U test was used to compare CRP levels, WBC count and MPV between the study groups.

RESULTS

Surgical outcomes were good in all children, with no residual leakage. A similar, predictable increase in inflammatory markers (CRP, WBS, MPV) was found in all groups: conventional cardiac surgery with ECC, hybrid treatment without ECC, and hybrid treatment with ECC. Comparison of these groups showed no statistically significant differences between levels of inflammatory markers as well as other clinical variables.

CONCLUSIONS

Hybrid septal defect closure induces systemic inflammatory response syndrome activation as measured by CRP level, WBC count, and MPV, which is similar to that observed after cardiac surgery using ECC. Elevations of CRP level, WBC count, and MPV were similar after hybrid treatment with or without ECC. No significant differences were noted between trends of postoperative changes in the levels of inflammatory markers after treatment.