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J Thorac Cardiovasc Surg 2010;139:174-180
© 2010 The American Association for Thoracic Surgery

Perioperative Management

Prevention of ischemia/reperfusion-induced pulmonary dysfunction after cardiopulmonary bypass with terminal leukocyte-depleted lung reperfusion

Hiroshi Kagawa, MD*, Kiyozo Morita, MD, Ryuichi Nagahori, MD, Gen Shinohara, MD, Katsushi Kinouchi, MD, Kazuhiro Hashimoto, MD

Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan

Received for publication April 16, 2009; revisions received July 14, 2009; accepted for publication August 9, 2009.

* Address for reprints: Hiroshi Kagawa, MD, Department of Cardiac Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan. (Email: hkagawa{at}jikei.ac.jp).

Objective: Pulmonary ischemia and reperfusion during routine open heart surgery with cardiopulmonary bypass can lead to pulmonary dysfunction and vasoconstriction, resulting in a high morbidity and mortality. We investigated whether ischemia/reperfusion-induced pulmonary dysfunction after full-flow cardiopulmonary bypass could be prevented by the infusion of leukocyte-depleted hypoxemic blood during the early phase of reperfusion (terminal leukocyte-depleted lung reperfusion) and whether the benefits of this method were nullified by using hyperoxemic blood for reperfusion.

Methods: Twenty-one neonatal piglets underwent 180 minutes of full-flow cardiopulmonary bypass with pulmonary artery occlusion, followed by reperfusion. The piglets were divided into 3 groups of 7 animals. In group I, uncontrolled reperfusion was achieved by unclamping the pulmonary artery. In contrast, pulmonary reperfusion was done with leukocyte-depleted hyperoxemic blood in group II or with leukocyte-depleted hypoxemic blood in group III for 15 minutes at a flow rate of 10 mL/min/kg before pulmonary artery unclamping. Then the animals were monitored for 120 minutes to evaluate post-cardiopulmonary bypass pulmonary function.

Results: Group I developed pulmonary dysfunction that was characterized by an increased alveolar-arterial oxygen difference (204 ± 57.7 mm Hg), pulmonary vasoconstriction, and decreased static lung compliance. Terminal leukocyte-depleted lung reperfusion attenuated post-cardiopulmonary bypass pulmonary dysfunction and vasoconstriction when hypoxemic blood was used for reperfusion (alveolar-arterial oxygen difference, 162 ± 61.0 mm Hg). In contrast, no benefit of terminal leukocyte-depleted lung reperfusion was detected after reperfusion with hyperoxemic blood (alveolar-arterial oxygen difference, 207 ± 60.8 mm Hg).

Conclusion: Reperfusion with leukocyte-depleted hypoxemic blood has a protective effect against ischemia/reperfusion-induced pulmonary dysfunction by reducing endothelial damage, cytokine release, and leukocyte activation.

Abbreviations and Acronyms A-aDO 2 = alveolar-arterial oxygen difference; CPB = cardiopulmonary bypass; ET-1 = endothelin-1; IL = interleukin; LA = left atrium; MPO = myeloperoxidase; NOx = nitrogen oxide; PA = pulmonary artery; PMN = polymorphonuclear neutrophil; Rp = pulmonary vascular resistance; SIRS = systemic inflammatory response syndrome; TLDLR = terminal leukocyte-depleted lung reperfusion; WBC = white blood cell




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[Abstract] [Full Text] [PDF]


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