Introduction: Prolonged pleural drainage (PD) is a common complication status post (s/p) Fontan procedure and is associated with short and long term morbidities. There are no descriptions of cytokines within the PD s/p Fontan to date. The purpose of this study was to compare cytokine profiles in PD s/p Fontan vs age-matched controls.
Hypothesis: Patients s/p Fontan will have higher cytokine levels within their PD compared to controls, and these cytokines will increase over time.
Methods: This prospective age-matched cohort study recruited 25 patients undergoing Fontan procedure and 15 bi-ventricular patients undergoing cardiopulmonary bypass surgery. Pleural fluid samples were taken on post-operative day (POD) 1-4, 7, and 10. Samples were not collected after additional procedures in the chest. Pro-inflammatory IL-8, MIP-1 β, TNF-α, and anti-inflammatory IL-10 were measured using Bio-Plex Assays. Univariate comparison was made in demographics, peri-operative characteristics, and change in cytokine from POD1 to day most distal from surgery (DMD).
Results: Median age was 3.7 yrs (IQR 2.8-3.9) for controls and 2.5 yrs (IQR 2.1-2.9) s/p Fontan (p=0.02). Median PD duration and volume per day was higher s/p Fontan (both p < 0.001). Cytokine concentrations did not differ s/p Fontan vs control on POD1. There was an increase in pro-inflammatory cytokines from POD1 to DMD s/p Fontan (all p < 0.01) and a decrease in the anti-inflammatory cytokine (p=0.001). There was no difference in cytokine level from POD1 to DMD among controls. Change over time for MIP-1 β and TNF-α was greater s/p Fontan compared to controls (both p < 0.01) (Fig 1).
Conclusions: Our study shows inflammatory cytokine levels in pleural fluid s/p Fontan rise out of proportion compared to bi-ventricular controls. This increase in cytokine might perpetuate prolonged PD. Further investigation is needed to examine clinical modifiers that can decrease pleural inflammation and possibly duration of chest tube drainage.