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Author Notes:

Author for correspondence: Robert W Elder, MD, Yale University School of Medicine, P.O. Box 208064, 333 Cedar Street, 3 LCI, New Haven, CT 06510, Telephone: 203-785-2022, Fax: 203-737-2786, Email: robert.elder@yale.edu



  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Pediatrics
  • Cardiovascular System & Cardiology
  • Congenital heart disease
  • Surgery
  • Adult congenital heart disease
  • Thymectomy
  • Immune function

Immunologic Aging in Adults with Congenital Heart Disease: Does Infant Sternotomy Matter?


Journal Title:

Pediatric Cardiology


Volume 36, Number 7


, Pages 1411-1416

Type of Work:

Article | Post-print: After Peer Review


Thymectomy is performed routinely in infants undergoing cardiothoracic surgery. Children post-sternotomy have decreased numbers of T lymphocytes, although the mechanisms involved and long-term consequences of this have not been defined. We hypothesized that lymphopenia in patients with adult congenital heart disease (ACHD) would be reflective of premature T cell maturation and exhaustion. Adults with ACHD who had sternotomy to repair congenital heart disease as infants (<1 year) and age-matched ACHD patients without prior sternotomy were studied using polychromatic flow cytometry interrogating markers of lymphocyte maturation, exhaustion and senescence. Group differences were analyzed using Mann–Whitney U and Fisher’s exact tests. Eighteen ACHD patients aged 21–40 years participated: 10 cases and 8 controls. Median age at sternotomy for cases was 52 days. Cases and controls were matched for age (28.9 vs. 29.1 years; p = 0.83), gender (p = 0.15) and race (p = 0.62) and had similar case complexity. Cases had a lower mean percentage of cytotoxic CD8 lymphocytes compared to controls (26.8 vs. 33.9 %; p = 0.016), with fewer naive, undifferentiated CD8 T cells (31.0 vs. 53.6 %; p = 0.027). CD8 cells expressing PD1, a marker of immune exhaustion, trended higher in cases versus controls (25.6 vs. 19.0 %; p = 0.083). Mean percentage of CD4 cells was higher in cases versus controls (65.6 vs. 59.6 %; p = 0.027), without differences in CD4 T cell maturation subtype. In summary, ACHD patients who undergo sternotomy as infants exhibit differences in T lymphocyte composition compared to ACHD controls, suggesting accelerated immunologic exhaustion. Investigation is warranted to assess the progressive nature and clinical impact of this immune phenotypic change.

Copyright information:

© 2015, Springer Science+Business Media New York.

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