Immune dysfunction in children after corrective surgery for congenital heart disease.

OBJECTIVE

To study the effect of open- and closed-heart surgery on the immune status of infants and children.

DESIGN

Prospective study. Data collected before anesthesia and surgery and 2 and 24 hrs after surgery.

SETTING

Operating room and pediatric ICU in a children's hospital.

PATIENTS: Children undergoing surgery for correction of congenital heart disease (age 3 months to 12 yrs). A total of 31 patients were studied (open-heart surgery, n = 25; closed-heart surgery, n = 6).

MEASUREMENTS AND MAIN

RESULTS

Increased neutrophil counts and lymphopenia were observed after both open- and closed-heart surgery. Serum levels of the complement components C3 and C4 were depressed after open-heart surgery, but not after closed procedures. The percentage of T3+ and T4+ lymphocytes, proliferative responses of the lymphocytes and serum immunoglobulin (Ig)G and IgM were decreased from preoperative levels after open-heart surgery. The percentage of T8+ lymphocytes and serum IgA levels did not change. Intraoperative variables and postoperative severity of illness (Pediatric Risk of Mortality score) did not correlate with immune suppression.

CONCLUSIONS

The immune system is affected after pediatric cardiac surgery, particularly after open-heart surgery.