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Observational Study
. 2024 Oct;39(7):1314-1322.
doi: 10.1177/02676591231189357. Epub 2023 Jul 19.

Children with single ventricle heart disease have a greater increase in sRAGE after cardiopulmonary bypass

Bonnie A Brooks  1   2 , Pranava Sinha  3   4 , Steven J Staffa  5 , Marni B Jacobs  6   7 , Robert J Freishtat  8   9 , Jason T Patregnani  10   11
Affiliations
Observational Study

Children with single ventricle heart disease have a greater increase in sRAGE after cardiopulmonary bypass

Bonnie A Brooks et al. Perfusion. 2024 Oct.

Abstract

Introduction: Reducing cardiopulmonary bypass (CPB) induced inflammatory injury is a potentially important strategy for children undergoing multiple operations for single ventricle palliation. We sought to characterize the soluble receptor for advanced glycation end products (sRAGE), a protein involved in acute lung injury and inflammation, in pediatric patients with congenital heart disease and hypothesized that patients undergoing single ventricle palliation would have higher levels of sRAGE following bypass than those with biventricular physiologies.

Methods: This was a prospective, observational study of children undergoing CPB. Plasma samples were obtained before and after bypass. sRAGE levels were measured and compared between those with biventricular and single ventricle heart disease using descriptive statistics and multivariate analysis for risk factors for lung injury.

Results: sRAGE levels were measured in 40 patients: 19 with biventricular and 21 with single ventricle heart disease. Children undergoing single ventricle palliation had a higher factor and percent increase in sRAGE levels when compared to patients with biventricular circulations (4.6 vs. 2.4, p = 0.002) and (364% vs. 181%, p = 0.014). The factor increase in sRAGE inversely correlated with the patient's preoperative oxygen saturation (Pearson correlation (r) = -0.43, p = 0.005) and was positively associated with red blood cell transfusion (coefficient = 0.011; 95% CI: 0.004, 0.017; p = 0.001).

Conclusions: Children with single ventricle physiology have greater increase in sRAGE following CPB as compared to children undergoing biventricular repair. Larger studies delineating the role of sRAGE in children undergoing single ventricle palliation may be beneficial in understanding how to prevent complications in this high-risk population.

Keywords: acute lung injury; acute respiratory distress syndrome; biomarker; cardiopulmonary bypass; congenital heart disease; inflammation; single ventricle.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Soluble RAGE (sRAGE) levels in plasma before and immediately after CPB by ventricle status. A greater factor increase was noted in single ventricle patients (p = 0.002) and a greater percent change was noted in single ventricle patients (p = 0.014). Data are presented as median and the interquartile range.
Figure 2.
Figure 2.
Pearson correlation between factor increase in sRAGE based on patient preoperative oxygen saturation. \ Points are plotted by sRAGE factor increase and baseline oxygen saturation. A moderate inverse relationship was found between these two variables.
See this image and copyright information in PMC

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