Surgery for congenital heart defects (CHD) is performed under cardiopulmonary bypass and accompanied by various factors affecting the child’s brain. However, there are currently few studies devoted to prevention of cerebral damage in children undergoing cardiac surgery.
OBJECTIVE
To establish the effect of renouncement of red blood cells for heart-lung machine filling to prevent cerebral damage in children with septal congenital heart disease undergoing on-pump cardiac surgery.
MATERIAL AND METHODS
The study included 40 children aged 14 [12-22.5] months. Mean weight of children was 8.8 [7.25-11] kg. All patients underwent radical correction of septal CHD under cardiopulmonary bypass. All patients were divided into 2 groups depending on the use of red blood cells for primary filling of heart-lung machine. Cerebral damage was assessed using 3 specific serum markers: protein S100β, neuron-specific enolase (NSE) and glial fibrillar acidic protein (GFAP) prior to surgery, after CPB and in 16 hours after surgery. Clinical assessment of cerebral injury was carried out using the Cornell Pediatric Delirium Assessment scale.
RESULTS
We analyzed certain intra- and postoperative factors: hemoglobin, oxygen transport indicators (cerebral oxygenation, lactate and venous saturation) and parameters of organ dysfunction (creatinine, urea, bilirubin, duration of artificial lung ventilation and ICU-stay). No between-group differences were found and all indicators were within the reference values. Thus, correction of congenital heart defects without transfusion is safe. In addition, concentration of specific markers of brain damage was significantly higher in the group of transfusion after CPB weaning: S100β — 522.1 [386.65-702.9] ng/L and 947.7 [696.93-1378.25] ng/L (p<0.001); NSE — 30.51 [22.8-36.99] ng/L and 44.92 [34.1-55.06] ng/L (p=0.007); GFAP — 0.1172 [0.1093-0.1198] ng/ml and 0.1238 [0.1195-0.1348] ng/ml (p=0.004). In addition, GFAP was higher in the same group in 16 hours after surgery — 0.11 [0.105-0.1197] ng/ml and 0.1212 [0.1177-0.1404] ng/ml (p=0.002).
CONCLUSION
Rejection of red blood cells for heart-lung machine filling is safe for prevention of cerebral injury.
