Hemoadsorption contribution in failing Fontan pediatric heart transplantation

Abstract

Background A systemic inflammatory response is triggered in patients undergoing cardiothoracic surgery with cardiopulmonary bypass. This response is particularly evident in pediatric patients, especially if of low weight and after undergoing long cardio-pulmonary by-pass (CPB), and can severely impair surgical result. Objectives Adsorptive blood purification techniques have been proposed to limit this systemic inflammatory response. To test its efficacy, we added the hemoadsorption filter Jafron HA 380 to CPB in a very compromised pediatric patient who underwent heart transplantation. Method A 10-year-old single ventricle patient previously treated with Fontan operation was listed for heart transplantation due to the evidence of failing Fontan condition. He experienced many episodes of cardiac arrest and underwent heart transplantation in very compromised general and hemodynamic conditions. The hemoadsorption filter Jafron HA 380 was used for all the duration of CPB and the inflammatory biomarker Interleukin 6 (IL-6) was assayed. Results Post-operative outcome was uneventful and comparable to that of an elective pediatric heart transplantation. The Interleukin 6 (IL-6) levels showed an impressive post-operative reduction and after 2 days the IL-6 level was comparable with a typical uneventful post-transplant course. Conclusions The use of hemoadsorption filter can contribute to improve pediatric transplant results especially in very high-risk patients.