Modifying risk for infant cardiopulmonary bypass: use of a miniaturized circuit and an asanguineous prime to reduce meutrophil-mediated organ dysfunction

Doctor's Name: 
Tara B. Karamlou, PhD
Oregon Health and Science University

Repair of severe forms of congenital heart disease requires the use of specific methods of heart-lung bypass, while the heart surgery is performed. Heart-lung bypass in infants, because of their small size, requires the use of blood to prime the heart-lung machine circuit. The use of blood has many well-known risks, including transmission of infectious diseases and mismatch reactions. Blood transfusions also sensitize individuals to antibodies found in donor blood, which can make it more difficult to find potential blood and organ donors for those patients. Infants and children with congenital heart disease are at particularly high risk considering their long life expectancy, and their potential need for multiple operations, and even heart or lung transplantation. In recent years, the use of blood, especially stored blood, has been shown to cause lung injury. This is known as transfusion-related acute lung injury (TRALI). The mechanism of injury is related to the activation of white blood cells in the recipient's body, which then activate inflammatory cascades, resulting in widespread damage to susceptible tissue beds. Certain patients are more prone to developing TRALI, including trauma patients, infants, and patients exposed to the heart-lung machine. Thus, children with congenital heart disease constitute a unique patient population at high risk for the complications of blood transfusion, and stand to benefit greatly from strategies that avoid its use. The goals of the experiment are: (1) to determine the effects of stored blood use during heart-lung bypass on the heart and lungs, and the biologic mechanisms responsible for these effects, and (2) to determine if adaptations to the currently used heart-lung bypass techniques, specifically avoidance of blood in the circuit, will improve organ function following congenital heart surgery.

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