Children with single ventricle heart disease have a greater increase in sRAGE after cardiopulmonary bypass

Authors

Bonnie A. Brooks, Division of Pediatric Critical Care Medicine, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, USA.
Pranava Sinha, Department of Pediatric Cardiac Surgery, M Health Fairview University of Minnesota, Minneapolis MN, USA.
Steven J. Staffa, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard University, Boston Children's Hospital, Boston, MA, USA.
Marni B. Jacobs, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, CA, USA.
Robert J. Freishtat, Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA.
Jason T. Patregnani, Division of Pediatric Critical Care Medicine, Maine Medical Center, Tufts University School of Medicine, Barbara Bush Children's Hospital, Portland, ME, USA.

Document Type

Article

Publication Date

7-19-2023

Institution/Department

Pediatrics; Cardiology

Journal Title

Perfusion

Abstract

INTRODUCTION: Reducing cardiopulmonary bypass (CPB) induced inflammatory injury is a potentially important strategy for children undergoing multiple operations for single ventricle palliation. We sought to characterize the soluble receptor for advanced glycation end products (sRAGE), a protein involved in acute lung injury and inflammation, in pediatric patients with congenital heart disease and hypothesized that patients undergoing single ventricle palliation would have higher levels of sRAGE following bypass than those with biventricular physiologies. METHODS: This was a prospective, observational study of children undergoing CPB. Plasma samples were obtained before and after bypass. sRAGE levels were measured and compared between those with biventricular and single ventricle heart disease using descriptive statistics and multivariate analysis for risk factors for lung injury. RESULTS: sRAGE levels were measured in 40 patients: 19 with biventricular and 21 with single ventricle heart disease. Children undergoing single ventricle palliation had a higher factor and percent increase in sRAGE levels when compared to patients with biventricular circulations (4.6 vs. 2.4, = 0.002) and (364% vs. 181%, = 0.014). The factor increase in sRAGE inversely correlated with the patient's preoperative oxygen saturation (Pearson correlation (r) = -0.43, = 0.005) and was positively associated with red blood cell transfusion (coefficient = 0.011; 95% CI: 0.004, 0.017; = 0.001). CONCLUSIONS: Children with single ventricle physiology have greater increase in sRAGE following CPB as compared to children undergoing biventricular repair. Larger studies delineating the role of sRAGE in children undergoing single ventricle palliation may be beneficial in understanding how to prevent complications in this high-risk population.

First Page

2676591231189357

Recommended Citation

Brooks BA, Sinha P, Staffa SJ, Jacobs MB, Freishtat RJ, Patregnani JT. Children with single ventricle heart disease have a greater increase in sRAGE after cardiopulmonary bypass [published online ahead of print, 2023 Jul 19]. Perfusion. 2023;2676591231189357. doi:10.1177/02676591231189357