Serum TNF-α levels in children with congenital heart disease undergoing cardiopulmonary bypass: A cohort study in China and a meta-analysis of the published literature.

OBJECTIVE: To investigate the changes in tumor necrosis factor alpha (TNF-α) serum levels after cardiopulmonary bypass (CPB) in children with congenital heart disease (CHD), followed by a meta-analysis to analyze the clinical value of TNF-α in CPB.

METHODS: Our cohort study enrolled 67 CHD children, assigned into off-pump group (n=32) and CPB group (n=35). The TNF-α serum levels in two groups were detected by ELISA before the operation (T1), at the end of the operation (0 hour, T2), and after 24 hours of the operation (T3). For meta-analysis, literature search was conducted to identify published case-control articles about the changes of TNF-α serum levels with CPB of CHD.

RESULTS: The TNF-α levels in CPB group were lower than that in the off-pump group at T3 (P=.006). TNF-α level at T3 was significantly lower than that at T1 and T2 (all P<.05). Meta-analysis results further confirmed that the TNF-α levels of CHD children were dramatically decreased at T3 as compared to that at T1 and T2 (both P<.001).

CONCLUSION: The TNF-α serum levels showed a transient and dramatic decline after 24 hours of CPB, and it may act as an important biological indicator for monitoring the efficacy of CPB in CHD children.