Effect of C1-esterase-inhibitor on capillary leak and inflammatory response syndrome during arterial switch operations in neonates

Objective: To determine if prophylactic administration of Cl-esterase-inhib itor would have a beneficial effect on postoperative weight gain and the in flammatory response in neonates undergoing cardiac surgery with cardiopulmo nary bypass (CPB). Design: Randomized, double-blinded study. Setting: University-affiliated heart center. Participants: Twenty-four neonates with transposition of the great arteries . Interventions: In group inhibitor (INH) patients (n = 12), 100 IU/kg of Cl- esterase-inhibitor (Berinert) was given 30 minutes before CPB. In group pla cebo (P) patients (n = 12), placebo was administered instead. Interleukin ( IL)-6, C3a anaphylatoxin, C1 activity, prekallikrein, Hageman factor, D-dim ers, and clinical parameters were measured 6 times perioperatively. Measurements and Main Results: All 24 patients had an uneventful clinical c ourse. Mean arterial pressure and pulmonary oxygenation after CPB were supe rior in group INH patients. The weight gain on postoperative days 1 to 4 wa s significantly less in group INH patients compared with group P (55 +/- 59 g vs. 340 +/- 121 g, day 1). The concentration of IL-6 (76 +/- 17 pg/mL vs . 262 +/- 95 pg/mL during CPB) was significantly lower in group INH patient s compared with group P patients. In contrast, no influence on C3a anaphyla toxin and coagulation factors was found. Conclusion: Prophylactic application of Cl-esterase-inhibitor in neonates u ndergoing arterial switch operations produces less inflammatory response co mpared with placebo. This difference may have contributed to improved clini cal parameters, including less weight gain postoperatively. Copyright (C) 2 001 by W.B. Saunders Company.