CONGENITAL – Original Submission| Volume 35, ISSUE 1, P105-112, March 2023

Triiodothyronine Supplementation in Infants Undergoing Cardiopulmonary Bypass: A Randomized Controlled Trial

Published:January 26, 2022DOI:
      Cardiopulmonary bypass (CPB) profoundly suppresses circulating thyroid hormone levels in infants. We performed a multicenter randomized placebo controlled trial to determine if triiodothyronine (T3) supplementation improves reduces time to extubation (TTE) in infants after CPB. Infants (n = 220) undergoing cardiac surgery with CPB and stratified into 2 age cohorts: ≤30 days and >30 days to <152 days were randomization to receive either intravenous triiodothyronine or placebo bolus followed by study drug infusion until extubated or at 48 hours, whichever preceded. T3 did not significantly alter the primary endpoint, TTE (hazard ratio for chance of extubation (1.08, 95% CI: 0.82–1.43, P = 0.575) in the entire randomized population with censoring at 21 days. T3 showed no significant effect on TTE (HR 0.82, 95% CI:0.55–1.23, P = 0.341) in the younger subgroup or in the older (HR 1.38, 95% CI:0.95–2.2, P = 0.095). T3 also did not significantly impact TTE during the first 48 hours while T3 levels were maintained (HR 1.371, 95% CI:0.942–1.95, P = 0.099) No significant differences occurred for arrhythmias or other sentinel adverse events in the entire cohort or in the subgroups. This trial showed no significant benefit on TTE in the entire cohort. T3 supplementation appears safe as it did not cause an increase in adverse events. The study implementation and analysis were complicated by marked variability in surgical risk, although risk categories were balanced between treatment groups.

      Graphical Abstract



      T3 (Triiodothyronine), CPB (Cardiopulmonary bypass), TTE (Time to Extubation), TRICC (Triiodothyronine during Cardiopulmonary bypass in Infants and Children)
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      Linked Article

      • Commentary: The Trials and Tribulations of T3 Supplementation
        Seminars in Thoracic and Cardiovascular SurgeryVol. 35Issue 1
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          In this issue of Seminars, Portman and colleagues report the results of a 3-center, randomized, controlled trial (RCT) of triiodothyronine (T3) supplementation in infants <152 days old undergoing cardiac surgery with cardiopulmonary bypass (CPB).1 They randomized 220 infants (103 neonates) and found no difference in their primary endpoint, time to extubation, or any secondary endpoints including vasoactive score, ICU length of stay (LOS), or presence of low cardiac output. This rigorously conducted RCT represents the culmination of years of work by the investigative team seeking to understand the potential benefits of T3 supplementation.
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