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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 234-241, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
A Finn, S Naik, N Klein, RJ Levinsky, S Strobel and M Elliott
Capillary leak after cardiopulmonary bypass operations for correction of
congenital heart defects is universally seen in children and often causes
significant morbidity and mortality. Since neutrophil-mediated endothelial
injury has been implicated as a pathogenetic mechanism, a prospective
controlled descriptive study was performed to investigate possible
activation pathways during and after the bypass procedure. Eighteen
children undergoing operations, nine with cardiopulmonary bypass and nine
neurosurgical craniotomy (i.e., operations without bypass), had samples of
arterial blood collected at intervals before, during, and after operations.
In six of nine cardiac patients circulating interleukin-8 concentrations
rose from less than 30 pg/ml to very high concentrations (> 500 pg/ml);
in the remaining three patients small rises (peak 57 to 81 pg/ml) were also
seen. In all nine, the rise commenced at the time of rewarming, toward the
end of bypass, and peaked 1 to 3 hours thereafter. Interleukin-8 release
correlated significantly with length of bypass. Interleukin-1 alpha and
interleukin-1 beta were not found, and traces of tumor necrosis factor-
alpha were detected in one patient only. Circulating elastase alpha 1-
antitrypsin concentrations rose simultaneously and correlated significantly
with interleukin-8 (p < 0.001) in patients with cardiac disease, as did
absolute neutrophil counts (p < 0.001). In contrast, only one of nine
patients with neurosurgical disease (undergoing an unusually long operation
and exchange transfusion) had a rise in circulating interleukin-8 to levels
greater than 500 pg/ml (p < 0.01). The two samples from this patient
with elevated interleukin-8 were the only neurosurgical samples with
elevated elastase. This study demonstrates the release of interleukin-8
into the circulation after pediatric hypothermic cardiopulmonary bypass and
supports the suggestion that this cytokine plays a role in the
pathophysiology of capillary leak through neutrophil degranulation.
ARTICLES
Interleukin-8 release and neutrophil degranulation after pediatric cardiopulmonary bypass
Division of Cell and Molecular Biology, Institute of Child Health, London, England.
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