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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 666-673, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
K Hashimoto, H Miyamoto, K Suzuki, S Horikoshi, M Matsui, T Arai and H Kurosawa
In this study the causes of organ damage after cardiopulmonary bypass were
multifactorial. The concentration of the proteolytic enzyme elastase, which
was released from activated granulocytes in the milieu of significantly
reduced levels of alpha 1-protease inhibitor (p less than 0.01), increased
during cardiopulmonary bypass (p less than 0.01). In addition, bypass
initiated platelet aggregation, which both altered the eicosanoid
metabolism and caused the level of thromboxane A2 to increase and surpass
the level of prostaglandin I2. Because thromboxane A2 dominance subsided
immediately after cardiopulmonary bypass, the effect of thromboxane A2
(vasoconstriction) on the development of organ damage may have been
influential only during bypass. Both during and after bypass, the increase
in endothelin excretion (p less than 0.01 to 0.05) was believed to induce a
further vasoconstriction in the microvasculature. On completion of the
cardiopulmonary bypass, the elevation of the lysosomal enzyme
beta-glucuronidase, which is a sensitive indicator of cellular damage, was
influenced by the concentrations of elastase (r = 0.8) and endothelin (r =
0.52). As evidenced by leuko-sequestration in the lung after
cardiopulmonary bypass, the increase in the alveolar-arterial oxygen
tension difference correlated with the elastase concentration (r = 0.68).
Renal damage, which was detected by an increase in renal tubular enzymes
(N-acetyl- beta-D-glucosaminidase and gamma-glutamyltranspeptidase) was
affected by the endothelin (r = 0.68, 0.56) and elastase levels (r = 0.58,
0.68), respectively, but not by the ratio of thromboxane B2 to
prostaglandin F1 alpha. The elastase level influenced the pulmonary
vascular resistance (r = 0.56). However, neither the cardiac index nor the
systemic and pulmonary vascular resistances were influenced by the
endothelin level and the ratio of thromboxane B2 to prostaglandin F1 alpha.
ARTICLES
Evidence of organ damage after cardiopulmonary bypass. The role of elastase and vasoactive mediators
Department of Cardiovascular Surgery, Jikei University School of Medicine, Tokyo, Japan.
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