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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 979-987, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
SW Davies, JP Duffy, DG Wickens, SM Underwood, A Hill, MF Alladine, RO Feneck, TL Dormandy and RK Walesby
Myocardial and pulmonary impairment after cardiopulmonary bypass may be
caused by oxygen free radicals produced by reperfusion and by activated
neutrophils. Free radical activity was assessed by assays for lipid
peroxidation (thiobarbituric acid-reactive material) and phospholipid-
esterified diene conjugation (18:2[9,11]/18:2[9,12] molar ratio) in 25
patients during coronary artery operations. Arterial blood samples were
obtained before, during the ischemic period, and for 24 hours thereafter.
There were no significant changes in free radical indices during the
ischemic periods, but after cessation of bypass they increased
significantly. Ten minutes after bypass thiobarbituric acid- reactive
material rose from 96 (median; range 65 to 145) nmol/gm albumin to 138 (85
to 200) nmol/gm albumin (p < 0.001), and molar ratio rose from 2.23%
(0.45% to 7.70%) to 2.51% (0.39% to 7.93%) (p < 0.02). Values of
thiobarbituric acid-reactive material subsequently decreased, but molar
ratio reached a peak at 4 hours after bypass, 2.64% (0.55% to 10.08%) (p
< 0.001), thereafter returning to baseline. The postoperative increases
in thiobarbituric acid-reactive material and in molar ratio were correlated
(r = +0.53; p = 0.006). These increases in thiobarbituric acid-reactive
material and in molar ratio were not related to age, preoperative left
ventricular function, or the number of grafts performed. Increase in
thiobarbituric acid-reactive material correlated with the duration of
cardiopulmonary bypass (r = +0.43; p = 0.03). In 10 patients in whom
cardiopulmonary bypass was performed using a bubble oxygenator, the
increases in thiobarbituric acid- reactive material were significantly
greater than in the 15 in whom a membrane oxygenator was used (p <
0.02). These data show that after apparently uncomplicated coronary
operations with bypass there is an increase in lipid peroxidation and diene
conjugation, indicating increased free radical activity. This increase
varies between patients and does not relate to patient or surgical factors
but may depend on the type of oxygenator employed during bypass.
ARTICLES
Time-course of free radical activity during coronary artery operations with cardiopulmonary bypass
Cardiac Department, London Chest Hospital, United Kingdom.
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