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Pediatric Cardiology

, Volume 40, Issue 4, pp 744–752 | Cite as

Analysis of Inflammatory Cytokines in Postoperative Fontan Pleural Drainage

  • Stephanie A. GoldsteinEmail author
  • Asaad G. Beshish
  • Lauren B. Bush
  • Ray E. Lowery
  • Joshua H. Wong
  • Kurt R. Schumacher
  • Nadine L. N. Halligan
  • Timothy T. Cornell
  • Albert P. Rocchini
Original Article

Abstract

Prolonged pleural drainage is a common complication in patients after Fontan palliation and is associated with short- and long- term morbidities. Among many potential etiologies, prolonged drainage has an inflammatory component, but there are no descriptions of cytokines in Fontan pleural drainage to date. This study aimed to examine the inflammatory make-up of Fontan pleural drainage. This prospective age-range-matched cohort study recruited 25 patients undergoing Fontan procedure and 15 bi-ventricular patients undergoing cardiopulmonary bypass (CPB). Chest tube samples were taken on postoperative day (POD) 1–4, 7, and 10. Cytokines were measured using Bio-Plex Assays. Univariate comparisons were made in patient characteristics and cytokine levels. Median age was 3.7 y (IQR 2.8–3.9) for controls and 2.5 y (IQR 2.1–2.9) in Fontan patients (p = 0.02). Median drainage duration and daily volume was higher in Fontan patients (both p < 0.001). Inflammatory cytokines (IL-17A, IFN-y, MIP-1β, and TNF-α) were higher in Fontan patients than controls (all p < 0.02). There was an increase in pro-inflammatory cytokines (IL-8, MIP-1β, and TNF-α) from POD1 to the last chest tube day (LCD) in Fontan patients (all p < 0.0001) and a decrease in the anti-inflammatory cytokine IL-10 (p = 0.001). There was no difference in cytokine concentration from POD1 to LCD among controls. There was a significant association with the cytokine concentration of TNF-α on POD1 and duration of chest tube drainage (p < 0.05). Inflammatory cytokine levels in the pleural fluid of Fontan patients are higher compared to bi-ventricular controls and rise over time where controls do not. This suggests ongoing localized inflammation that is not a result of CPB alone and may be an important contributor to pleural drainage in patients after the Fontan procedure.

Keywords

Fontan physiology Inflammation Postoperative Effusions 

Notes

Acknowledgements

The following people were paramount in the collection and storage of samples: Katherine Fatum RN BSN, Janine Stoscup RN BSN, Karianne Marchetti RN BSN, Katie Jarvis RN BSN, Holli Clewis RN BSN. Walker McHugh and Kevin Walker assisted with laboratory protocols.

Funding

Funding was provided by the Strecher award for fellowship research, Ann Arbor, MI.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Stephanie A. Goldstein
    • 1
    Email author
  • Asaad G. Beshish
    • 2
  • Lauren B. Bush
    • 1
  • Ray E. Lowery
    • 1
  • Joshua H. Wong
    • 3
  • Kurt R. Schumacher
    • 1
  • Nadine L. N. Halligan
    • 1
  • Timothy T. Cornell
    • 2
  • Albert P. Rocchini
    • 1
  1. 1.University of Michigan Congenital Heart CenterAnn ArborUSA
  2. 2.Lucile Packard Children’s HospitalPalo AltoUSA
  3. 3.Advocate Children’s HospitalOak LawnUSA

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