RELEASE OF SOLUBLE TUMOR-NECROSIS-FACTOR-ALPHA RECEPTORS DURING AND AFTER PEDIATRIC CARDIOPULMONARY BYPASS - CORRELATION WITH HEMODYNAMIC AND CLINICAL-VARIABLES

The release of cytokines during cardiopulmonary bypass (CPB) may contr ibute to haemodynamic alternations encountered after open heart surger y, Regulatory mechanisms exist and include soluble cytokine receptors, We have measured blood levels of tumour necrosis factor (TNF) and its soluble receptor (TNFsr) during and after open heart surgery in child ren, Correlation analysis to haemodynamic and clinical variables was p erformed. Using immunoassays the authors registered a significant incr ease in plasma levels of TNFsr with peak levels 2 h post-operatively a t a level of 1702 +/- 170 pg/ml, The concentration of TNFsr remained s ignificantly elevated until 48 h postoperatively but TNF was not signi ficantly elevated. An inverse correlation existed between peak TNFsr a nd mean arterial pressure (rho = -0.827, P < 0.05), between TNFsr and cardiac index (rho = -0.8, P < 0.05), between TNFsr and left ventricul ar stroke work index (rho = -0.983, P < 0.01), between TNFsr and weigh t (rho = -0.85, P < 0.05) and between TNFsr and body surface area (rho = -0.867, P < 0.05). The authors demonstrate that the smallest childr en experienced the highest TNFsr concentration post-operatively. Furth ermore cardiac performance, expressed as cardiac index and left ventri cular stroke work index, correlated inversely to peak TNFsr level post -operatively.