Long-term immunological changes after corrective cardiac surgery.
Level 4 - case-series / case-control
Single-center case series of 22 patients without an unexposed control group
PubMed 39474990 · doi:10.1111/sji.13418
What was done
Researchers evaluated 22 pediatric patients who underwent thymectomy during corrective cardiac surgery in infancy and were followed at Marmara University Pediatric Allergy and Immunology Clinic. The evaluation included clinical history of infections, allergies, and autoimmunity, alongside laboratory testing for immunoglobulins, vaccine responses, lymphocyte subset analyses, T-cell upregulation, T-cell proliferation, and T-cell receptor excision circles (TRECs).
What was found
Sixteen patients had a history of infection, including six serious infections occurring within the first year of life. Lymphopenia occurred in 27% of patients, with decreased naive CD4+ and recent thymic emigrant T-cell counts and an increased proportion of memory T cells. Low levels of IgG, IgA, and IgM were found in 36%, 40%, and 22% of patients, respectively. Vaccine responses were positive in 90% of patients. TREC levels were low in all 10 patients tested, and normal T-cell proliferation was present in 7 of 9 tested patients. Allergic disease was present in 22% of patients, and no autoimmunity was detected.
Why it matters
The study indicates that infant thymectomy can result in long-term features of premature immune senescence and humoral alterations, supporting efforts to preserve thymic tissue during pediatric cardiac surgery.
Limits
The study is limited by a small sample size (n = 22), single-center design, and the absence of a control cohort. Additionally, specific laboratory tests were only performed in subsets of the cohort (TREC in 10 patients, proliferation in 9 patients), and exact follow-up duration was not specified in the abstract.
Cited by
- contradicts Historically, surgical removal of the thymus in children undergoing thoracic or exploratory heart surgery caused them to suffer and die from opportunistic bacterial and viral infections.