Neutrophil extracellular traps formation is associated with postoperative complications in congenital cardiac surgery 2127

Abstract Description Pediatric patients with congenital heart disease (CHD) often require surgical repair using cardiopulmonary bypass. Despite advancements, mortality and complication rates remain significant. We examined 101 patients undergoing congenital cardiac surgery, identifying a mortality rate of 4.0% and a complication rate of 31.6%. Neonates and infants exhibited more multiple complications. Prolonged bypass time was significantly associated with complications, with each additional 30 minutes increasing the odds by 1.46 times (95%CI 1.01-2.10, p = 0.042). We further investigated the involvement of damage-associated molecular pattern (DAMP) molecules - endogenous molecules released from injured or damaged tissues. Plasma levels of DAMPs, including histones and high mobility group box 1 (HMGB1), were significantly elevated in the complication group. As these molecules target Toll-like receptor (TLR)2 and TLR4, mRNA expression of TLR2 and TLR4 in neutrophils was upregulated in the complication group. In vitro and in vivo analyses demonstrated that histones and HMGB1 induced the formation of neutrophil extracellular traps (NETs). This finding aligned with greater NETs formation observed at the end of cardiopulmonary bypass (CPB) and during the postoperative period in neonates and infants who developed postoperative complications. Targeting NETs and associated DAMPs may provide a novel therapeutic approach to mitigate complications in this patient population. Funding Sources NIH HD109119 Topic Categories Translational and Interventional Immunology (TI)