Effective Pulmonary Artery Perfusion Mode during Cardiopulmonary Bypass
Aim: Reducing lung injury during cardiopulmonary bypass (CPB) is important for patients' recovery. The present study was designed to research convenient and effective pulmonary artery perfusion mode during CPB in an animal model.
Methods: Twelve healthy mongrel dogs were randomly divided into 2 groups: a control group and a perfusion group designed to simulate clinical CPB-induced lung injury. During CPB, pulmonary artery perfusion with modified lowpotassium dextran (LPD) solution was performed immediately after the initiation of ischemia and before reperfusion for 3 to 4 minutes each time, with pressure maintained at 15 to 20 mmHg; animals in the control group were not perfused. After pulmonary reperfusion, the changes in pulmonary function and tissue biochemical data were determined.
Results: Compared with the control group, lung compliance, oxygenation, and vascular resistance after reperfusion were significantly improved in the perfusion group. The malonaldehyde concentration, neutrophil sequestration ratio, and tissue water content also decreased significantly in the perfusion group.
Conclusion: The pulmonary artery perfusion mode used in this experiment could relieve CPB-induced lung injury effectively. Improving cellular tolerance to hypoxia and decreasing inflammatory reaction may be the important mechanisms. Moreover, this mode is convenient and does not interfere with the intended operations, which is promising for clinical use.
Bernal-Mizrachi L, Jy W, Fierro C, et al. 2004. Endothelial microparticles correlate with high-risk angiographic lesions in acute coronary syndromes. Int J Cardiol 97:439-46.nBoyle EM Jr, Pohlman TH, Johnson MC, Verrier ED. 1997. Endothelial cell injury in cardiovascular surgery: the systemic inflammatory response. Ann Thorac Surg 63:277-84.nDavis ME, Cai H, Drummond GR, Harrison DG. 2001. Shear stress regulates endothelial nitric oxide synthase expression through c-Src by divergent signaling pathways. Circ Res 89:1073-80.nDeCampos KN, Keshavjee S, Liu M, Slutsky AS. 1998. Prevention of rapid reperfusion-induced lung injury with prostaglandin E1 during the initial period of reperfusion. J Heart Lung Transplant 17:1121-8.nGabriel EA, Fagionato Locali R, Katsumi Matsuoka P, et al. 2008. Lung perfusion during cardiac surgery with cardiopulmonary bypass: is it necessary? Interact Cardiovasc Thorac Surg 7:1089-95.nGimbrone MA Jr, Topper JN, Nagel T, Anderson KR, Garcia-Cardeña G. 2000. Endothelial dysfunction, hemodynamic forces, and atherogenesis. Ann N Y Acad Sci 902:230-9.nGoebel U, Siepe M, Mecklenburg A, et al. 2008. Reduced pulmonary inflammatory response during cardiopulmonary bypass: effects of combined pulmonary perfusion and carbon monoxide inhalation. Eur J Cardiothorac Surg 34:1165-72.nHalldorsson A, Kronon M, Allen BS, et al. 1998. Controlled reperfusion after lung ischemia: implications for improved function after lung transplantation. J Thorac Cardiovasc Surg 115:415-24.nHalldorsson AO, Kronon MT, Allen BS, Rahman S, Wang T. 2000. Lowering reperfusion pressure reduces the injury after pulmonary ischemia. Ann Thorac Surg 69:198-204.nLiu Y, Wang Q, Zhu X, et al. 2000. Pulmonary artery perfusion with protective solution reduces lung injury after cardiopulmonary bypass. Ann Thorac Surg 69:1402-7.nMills AN, Hooper TL, Hall SM, McGregor CG, Haworth SG. 1992. Unilateral lung transplantation: ultrastructural studies of ischemia-reperfusion injury and repair in the canine pulmonary vasculature. J Heart Lung Transplant 11:58-67.nNagel T, Resnick N, Atkinson WJ, Dewey CF Jr, Gimbrone MA Jr. 1994. Shear stress selectively upregulates intercellular adhesion molecule-1 expression in cultured human vascular endothelial cells. J Clin Invest 94:885-91.nReinhart WH. 1994. Shear-dependence of endothelial functions. Experientia 50:87-93.nPearl JM, Schwartz SM, Nelson DP, et al. 2004. Preoperative glucocorticoids decrease pulmonary hypertension in piglets after cardiopulmonary bypass and circulatory arrest. Ann Thorac Surg 77:994-1000.nSchnickel GT, Ross DJ, Beygui R, et al. 2006. Modified reperfusion in clinical lung transplantation: the results of 100 consecutive cases. J Thorac Cardiovasc Surg 131:218-23.nSiepe M, Goebel U, Mecklenburg A, et al. 2008. Pulsatile pulmonary perfusion during cardiopulmonary bypass reduces the pulmonary inflammatory response. Ann Thorac Surg 86:115-22.nSterpetti AV, Cucina A, Morena AR, et al. 1993. Shear stress increases the release of interleukin-1 and interleukin-6 by aortic endothelial cells. Surgery 114:911-4.nStrüber M, Hohlfeld JM, Fraund S, Kim P, Warnecke G, Haverich A. 2000. Low-potassium dextran solution ameliorates reperfusion injury of the lung and protects surfactant function. J Thorac Cardiovasc Surg 120:566-72.nVerrier ED, Morgan EN. 1998. Endothelial response to cardiopulmonary bypass surgery. Ann Thorac Surg 66:S17-9.nWei B, Liu Y, Wang Q, et al. 2004. Lung perfusion with protective solution relieves lung injury in corrections of Tetralogy of Fallot. Ann Thorac Surg 77:918-24.n
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).