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

Robert W. Elder*, Roshan P. George, Nancy M. McCabe, Fred H. Rodriguez, Wendy M. Book, William T. Mahle, Allan D. Kirk

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


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.

Original languageEnglish
Pages (from-to)1411-1416
Number of pages6
JournalPediatric Cardiology
Issue number7
StatePublished - 22 Oct 2015
Externally publishedYes


  • Adult congenital heart disease
  • Congenital heart disease
  • Immune function
  • Surgery
  • Thymectomy


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