Probiotics might relieve intestinal impairment caused by cardiopulmonary bypass in children

Dear Editor

I discovered the article by Toritsuka et al. [1] to be rather captivating. This research examines the possibility of probiotics in reducing intestinal harm following cardiopulmonary bypass (CPB) in paediatric patients having congenital heart disease. Though the investigation offers precious perceptions regarding the influence of CPB on gut microbiota and intestinal function, several matters of concern and potential enhancements are discerned in this crucial assessment.

The study’s concentration on intestinal ischaemia–reperfusion injury and its implications for gut microbiota and bacterial translocation is praiseworthy. Nevertheless, the study’s sample consisting of 82 patients could be regarded as restricted for conclusive outcomes, especially considering the substantial clinical implications of the discoveries. The randomized and prospective layout of the study is suitable, but the absence of a longer-term follow-up after surgery restricts the comprehension of the long-term impacts of probiotic administration. Additionally, the study’s dependence on faecal and blood samples for microbiota analysis might not completely capture the intricacy of gut microbiota alterations post CPB. The results indicating a higher number of obligate anaerobes in the intervention group are fascinating, but the study fails to furnish adequate evidence to firmly ascribe this to the probiotic treatment. Moreover, the absence of significant disparities in organic acid concentrations and other crucial markers of intestinal damage between the intervention and control groups raise doubts regarding the effectiveness of the probiotic treatment. The authors’ discourse on the limitations of the study, such as the limited sample size and the non-existence of a control group receiving a different probiotic strain, is an admirable recognition of the study’s deficiencies. However, the suggestion that the study’s results might still imply preventive effects against dysbiosis demands more solid evidence. While the study presents valuable initial data on the potential role of probiotics in reducing CPB-induced intestinal damage, the findings are not conclusive. Further research with larger sample volumes, longer follow-up intervals and a more comprehensive analysis of gut microbiota changes would be requisite to substantiate the claims put forth in this study.

In conclusion, although this study adds to the understanding of gut microbiota changes post CPB, it fails to offer definite proof for the efficacy of probiotics in this context. The study’s limitations and the necessity for further research are emphasized in this critical analysis, with the aim of advancing the knowledge in the field and stimulating more comprehensive inquiries into this significant topic.

FUNDING

This study was funded by the Natural Science Foundation of Chongqing (CSTB2023NSCQ-MSX0956), teaching research project of Army Medical University (2023B23), special project of improving scientific and technological innovation ability of Army Medical University (2023XJS35), and Xinqiao hospital Young Doctor Incubation Program (2022YQB033).

Conflict of interest: none declared.

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