The clinical implications of the systemic inflammatory reaction related to cardiac operations in children

Cardiac surgery involving cardiopulmonary bypass in children is related to a systemic inflammatory response that comprises activation of complement, stimulation and degranulation of leucocytes, synthesis cytokines, and increased interactions between the leucocytes and the endothelium. Contact between blood and foreign surfaces during cardiopulmonary bypass, and ischemia-reperfusion injury, are probably the main inductors of this complex reaction of the organism, primarily acting as a mechanism of homeostasis. Due to reasons as yet unclarified, the systemic inflammatory reaction can become uncontrolled, and then becomes the direct cause of specific postoperative morbidity. Complications, such as the capillary leak syndrome, the multiple organ dysfunction syndrome, and certain types of transient postoperative arrhythmias, are examples for this in neonates and young children. Technical and pharmacological interventions aimed at modulating, but not completely suppressing, the systemic inflammatory response occurring during cardiac surgery are promising in providing substantial protection for the organs. Besides the further clarification of the pathophysiological mechanisms contributing to the systemic inflammatory response to cardiac surgery, modulation of the balance between pro- and anti-inflammatory mediators, and stratification of the risk in our population of patients, together with excellent operative and standard postoperative treatment, are mandatory for the achievement of very low postoperative morbidity. © Greenwich Medical Media Ltd.