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J Thorac Cardiovasc Surg 2001;121:1137-1142
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Pulmonary metabolism of endothelin 1 during on-pump and beating heart coronary artery bypass operations

From the Departments of Surgery,^a Medicine,^b and Anesthesia,^c Montreal Heart Institute, Montreal, Quebec, Canada.

Supported by the Medical Research Council of Canada, the Quebec Heart and Stroke Foundation, the Fonds de la Recherche en Santé du Québec, and the Fonds de Recherche de l'Institut de Cardiologie de Montréal.

Received for publication March 29, 2000. Revisions requested Sept 8, 2000;revisions received Oct 11, 2000. Accepted for publication Nov 16, 2000. Address for reprints: Jocelyn Dupuis, MD, PhD, Research Center, Montreal Heart Institute, 5000 Belanger St E, Montreal, Quebec H1T 1C8, Canada (E-mail: dupuisj{at}icm.umontreal.ca).

Background: Coronary artery bypass operations are associated with increased circulating levels of the powerful vasoconstrictor endothelin 1. The pulmonary circulation is an important site for both production and clearance of endothelin 1. Lung endothelial injury resulting from cardiopulmonary bypass could modify pulmonary endothelin 1 metabolism through an increase in production, a reduction in removal, or a combination of both.
Methods: Pulmonary endothelin 1 kinetics were quantified by using the indicator-dilution technique in patients undergoing coronary artery bypass grafting with (n = 11) or without cardiopulmonary bypass (ie, beating heart; n = 10). Mixed venous endothelin 1 levels were also measured in samples from the pulmonary artery, and systemic levels were obtained from the radial artery.
Results: Pulmonary artery endothelin 1 levels were similar before and after cardiopulmonary bypass, with means of 1.59 ± 0.37 pg/mL and 1.33 ± 0.15 pg/mL (P = .45), respectively. Systemic endothelin 1 levels, however, increased after bypass from 1.64 ± 0.22 pg/mL to 2.07 ± 0.16 pg/mL (P = .01). In the beating heart group, endothelin 1 levels before and after the operation were similar in the pulmonary artery (1.25 ± 0.27 pg/mL and 1.45 ± 0.31 pg/mL, respectively; P = .38), as well as in the radial artery (1.70 ± 0.26 pg/mL and 1.73 ± 0.35 pg/mL, respectively; P = .92). The capacity to clear endothelin 1 from the pulmonary circulation, as computed from the permeability–surface area product for endothelin 1, was not affected by cardiopulmonary bypass before and after the operation (25.19 ± 2.67 mL/s and 23.12 ± 4.39 mL/s, respectively; P = .49). It was similar and also unaffected in the beating heart group.
Conclusion: Coronary artery bypass grafting with cardiopulmonary bypass is associated with an increase in systemic endothelin 1 levels. The mechanism involved is not related to a decreased pulmonary clearance of endothelin 1 from the systemic circulation but rather to an increased endothelin 1 release by the lungs.

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