beta-chemokine secretion patterns in relation to clinical course and outcome in children after cardiopulmonary bypass: Continuing the search to abrogate systemic inflammatory response

Background. Surgery involving cardiopulmonary bypass (CPB) is frequently ac companied by a systemic inflammatory response partly triggered by neutrophi ls and monocyte-macrophages. Certain cytokines that are powerful leukocyte- chemotactic factors have recently been characterized and shown to be import ant in evoking inflammatory responses: monocyte chemoattractant protein-1 ( MCP-1) has monocyte-macrophage chemotactic activity, and regulated-upon-act ivation normal T-cell expressed and secreted (RANTES) has a potent chemoatt ractant activity for mononuclear phagocytes. This prospective cohort study investigated possible roles of these chemokines in the inflammatory respons e to CPB and relationships between the changes in chemokine levels and the clinical course and outcome. Methods. Systemic blood of 16 children undergoing CPB was collected after i nduction of anesthesia (base line); at 15 minutes after bypass onset; at CP B cessation; and at 1, 2, 4, 8, 12, and 24 hours afterward to measure MCP-I and RANTES. Results. The significant changes of plasma beta chemokine levels following CPB were associated with patient characteristics, operative variables, and postoperative course. Cardiopulmonary bypass of more than 2 hours, longer s urgical times, inotropic support, and reoperation were associated with high er MCP-1 levels and lower RANTES levels. Conclusions. Our results suggest a relation between CPB-induced mediators a nd clinical effects, implying pathogenic roles for chemokines following CPB . These molecules should be considered as possible targets for therapeutic intervention. (Ann Thorac Surg 2001;71:233-7) (C) 2001 by The Society of Th oracic Surgeons.