Children's National Heart Institute, Children's National Hospital, Washington, DC, USA.
Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA.
Transfusion. 2024 May;64(5):808-823. doi: 10.1111/trf.17821. Epub 2024 Apr 8.
Phthalate chemicals are used to manufacture plastic medical products, including many components of cardiopulmonary bypass (CPB) circuits. We aimed to quantify iatrogenic phthalate exposure in pediatric patients undergoing cardiac surgery and examine the link between phthalate exposure and postoperative outcomes.
The study included pediatric patients undergoing (n=122) unique cardiac surgeries at Children's National Hospital. For each patient, a single plasma sample was collected preoperatively and two additional samples were collected postoperatively upon return from the operating room and the morning after surgery. Concentrations of di(2-ethylhexyl) phthalate (DEHP) and its metabolites were quantified using ultra high-pressure liquid chromatography coupled to mass spectrometry.
Patients were subdivided into three groups, according to surgical procedure: (1) cardiac surgery not requiring CPB support, (2) cardiac surgery requiring CPB with a crystalloid prime, and (3) cardiac surgery requiring CPB with red blood cells (RBCs) to prime the circuit. Phthalate metabolites were detected in all patients, and postoperative phthalate levels were highest in patients undergoing CPB with an RBC-based prime. Age-matched (<1 year) CPB patients with elevated phthalate exposure were more likely to experience postoperative complications. RBC washing was an effective strategy to reduce phthalate levels in CPB prime.
Pediatric cardiac surgery patients are exposed to phthalate chemicals from plastic medical products, and the degree of exposure increases in the context of CPB with an RBC-based prime. Additional studies are warranted to measure the direct effect of phthalates on patient health outcomes and investigate mitigation strategies to reduce exposure.
邻苯二甲酸酯类化学物质被用于制造塑料医疗器械，包括心肺转流（CPB）回路的许多组件。我们旨在量化接受心脏手术的儿科患者的医源性邻苯二甲酸酯暴露，并研究邻苯二甲酸酯暴露与术后结果之间的关系。
该研究纳入了在儿童国家医院接受（n=122）独特心脏手术的儿科患者。对于每位患者，在术前采集单个血浆样本，并在从手术室返回后和术后第二天早上分别采集另外两个样本。使用超高效液相色谱-质谱联用技术定量测定二（2-乙基己基）邻苯二甲酸酯（DEHP）及其代谢物的浓度。
根据手术程序将患者分为三组：（1）不需要 CPB 支持的心脏手术，（2）需要 CPB 支持且使用晶体预充的心脏手术，以及（3）需要使用 RBC 预充 CPB 回路的心脏手术。所有患者均检测到邻苯二甲酸酯代谢物，并且使用 RBC 预充 CPB 回路的患者术后邻苯二甲酸酯水平最高。年龄匹配（<1 岁）、邻苯二甲酸酯暴露水平升高的 CPB 患者更有可能出现术后并发症。CPB 预充时进行 RBC 洗涤是降低邻苯二甲酸酯水平的有效策略。
儿科心脏手术患者会接触到来自塑料医疗器械的邻苯二甲酸酯类化学物质，而在使用 RBC 预充 CPB 的情况下，暴露程度会增加。需要进一步研究来测量邻苯二甲酸酯对患者健康结果的直接影响，并研究减轻暴露的策略。
