title: Granulocyte sequestration and early failure in the autoperfused heart-lung preparation.
abstract: We investigated the role of pulmonary granulocyte sequestration in the development of early failure of the autoperfused working heart-lung preparation. A significant decline in the total circulating leukocyte count in 21 preparations at 60 minutes of perfusion (5.0 to 1.4 x 10(3)/microL; 28% of baseline; p less than 0.001) was observed. Differential cell counts in 14 of these preparations revealed a predominant decrease in granulocyte count (8.7% of baseline) and a moderate decline in lymphocyte count (46% of baseline). In study I, indium 111-labeled autologous granulocytes were injected intravenously into 10 adult New Zealand White rabbits. In group I (n = 5), an autoperfused working heart-lung preparation was harvested and perfused for 60 minutes. In group II (controls, n = 5), the heart-lung block was harvested following 60 minutes of in situ perfusion. Organ blocks were imaged before and after saline flush. There was a significant decline in granulocyte counts at 60 minutes of perfusion in group I versus no change in group II (I, 2.3 +/- 0.4 to 0.3 +/- 0.1; p less than 0.01; II, 1.7 +/- 0.2 to 2.3 +/- 0.5; not significant; x 10(3)/microL +/- standard error of the mean). Postflush lung activity was significantly increased in group I versus group II (I, 3,751 +/- 566; II, 1,867 +/- 532; p less than 0.05; counts +/- standard error of the mean). In study II, 15 autoperfused preparations were divided into two groups. Group I (n = 10) preparations were controls. Group II (n = 5) animals were depleted of leukocytes by pretreating with nitrogen mustard. Group I (controls) produced a bimodal survival distribution (Ia, 8.2 +/- 1.0; Ib, 26.4 +/- 2.0; hours +/- standard error of the mean). Group II survival was significantly longer than that of group Ia and similar to that of group Ib (II, 25.3 +/- 2.2; p less than 0.01 versus group Ia, not significant versus group Ib; hours +/- standard error of the mean). Hemodynamic profiles for group II closely paralleled those of group Ib. In conclusion, pulmonary sequestration of granulocytes occurs early in the autoperfused working heart-lung preparation (within 60 minutes of autoperfusion), and preoperative leukocyte depletion prolongs survival of the autoperfused working heart-lung preparation by eliminating the subset group Ia (short survivors) seen in untreated preparations.
authors.affiliation: Department of Cardiothoracic Surgery and Pediatric Critical Care, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: C M
authors.initials: CM
authors.lastname: Genco
authors.forename: R J
authors.initials: RJ
authors.lastname: Connolly
authors.forename: M B
authors.initials: MB
authors.lastname: Peterson
authors.forename: E A
authors.initials: EA
authors.lastname: Bernstein
authors.forename: K
authors.initials: K
authors.lastname: Ramberg
authors.forename: X
authors.initials: X
authors.lastname: Zhang
authors.forename: R J
authors.initials: RJ
authors.lastname: Cleveland
authors.forename: J T
authors.initials: JT
authors.lastname: Diehl
mesh_terms: D000818:Animals; D001784:Blood Gas Analysis; D001794:Blood Pressure; D002302:Cardiac Output; D006098:Granulocytes / Q000000981:diagnostic imaging / Q000502:physiology*; D006321:Heart; D007958:Leukocyte Count; D008168:Lung; D008170:Lung Compliance; D009926:Organ Preservation / Q000379:methods*; D010976:Platelet Count; D011651:Pulmonary Artery / Q000502:physiology; D011817:Rabbits; D011877:Radionuclide Imaging; D014022:Tissue Survival