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Abstract
Cardiac surgery using cardiopulmonary bypass (CPB) provokes a systemic inflammatory response. This is mainly triggered by contact activation of blood by artificial surfaces of the cardiopulmonary bypass circuit. Although this inflammatory response is often remaining sub-clinical and resolves promptly at the end of CPB, it may be (in its most extreme form) associated with the development of the systemic inflammatory response syndrome (SIRS) that can often lead to major organ dysfunction and death.
Pediatric patients are considered more susceptible to the inflammatory response to CPB for several reasons including higher metabolic demands, reactive pulmonary vasculature, and immature organ systems. The combination of a relatively larger CPB circuit and the increased flow rates necessary for younger and smaller patients results in greater exposure of the blood to the foreign surface of the bypass circuit which increases the effects of the systemic inflammatory response syndrome.
Cardiopulmonary dysfunction is present to some degree in every patient having open heart surgery and the inflammatory response is increasingly recognized as a major contributor to postoperative myocardial dysfunction.