IMMUNE DYSFUNCTION IN CHILDREN AFTER CORRECTIVE SURGERY FOR CONGENITAL HEART-DISEASE

Objective: To study the effect of open- and closed-heart surgery on the immune status of infants and children. Design: Prospective study. Data collected before anesthesia and surgery and 2 and 24 hrs after surgery. Setting: Operating room and pediatric ICU in a children's hospital. Patients: Children undergoing surgery for correction of congenital heart disease (age 3 months to 12 yrs). A total of 31 patients were studied (open-heart surgery, n = 25; closed-heart surgery, n = 6). Measurements and Main Results: Increased neutrophil counts and lymphopenia were observed after both open- and closed-heart surgery. Serum levels of the complement components C3 and C4 were depressed after open-heart surgery, but not after closed procedures. The percentage of T3+ and T4+ lymphocytes, proliferative responses of the lymphocytes and serum immunoglobulin (Ig)G and IgM were decreased from preoperative levels after open-heart surgery. The percentage of T8+ lymphocytes and serum IgA levels did not change. Intraoperative variables and postoperative severity of illness (Pediatric Risk of Mortality score) did not correlate with immune suppression. Conclusions: The immune system is affected after pediatric cardiac surgery, particularly after open-heart surgery.