Effects of a paf-receptor antagonist on hemodynamics during and after cardiopulmonary bypass.
OBJECTIVE
To assess after cardiopulmonary bypass (CPB) the role of paf-acether (paf), a phospholipid mediator whose injection in animal mimics the hemodynamics observed after CPB.


METHODS
Prospective double-blind randomized study.


METHODS
Single institutional university hospital.


METHODS
18 patients scheduled to undergo coronary artery bypass graft.


METHODS
18 patients randomly received a placebo (n = 8) or 120 mg BN52021 (n = 10), a paf-receptor antagonist injected twice just before vascular cannulation and before cross-clamp release.


RESULTS
Hemodynamic measurements were performed with a pulmonary artery and a radial artery catheter before and after the first injection of BN52021 or placebo, at the end of CPB, 1, 15, and 30 minutes after protamine infusion, then 6 hours and 24 hours postoperatively. BN52021 infusion, did not affect hemodynamic parameters. After CPB, the pulmonary artery pressures, the cardiac index, and the pulmonary artery occlusion pressures were statistically the same between groups. By contrast, the pulmonary vascular resistances (1.5 +/- 0.5 IU v 4.5 +/- 0.6 IU, p < 0.05), the right ventricular systolic work index (5.3 +/- 0.91 g m m-2 v 9.37 +/- 1.02 g m m-2, p < 0.05) and the transpulmonary gradient (4.7 +/- 1.1 mmHg v 12.0 +/- 1.2 mmHg, p < 0.05) were lower in the BN52021 group as compared with the placebo group. After protamine infusion, these differences between groups disappeared.


CONCLUSIONS
Because the inotropic and vasodilator therapy and the volume loading were the same between groups, this study suggests that pretreatment with a paf-receptor antagonist improves post-CPB pulmonary resistance. Nevertheless, this beneficial effect is transient without consequences on left ventricular function indices.
Nathan
N
N
Department of Anesthesiology, CHU Dupuytren, France.
Mercury
P
P
Denizot
Y
Y
Cornu
E
E
Laskar
M
M
Lathelize
M
M
Arnoux
B
B
Feiss
P
P
D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D004224:Diterpenes; D004311:Double-Blind Method; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D046934:Ginkgolides; D006439:Hemodynamics / Q000187:drug effects; D006494:Heparin Antagonists / Q000627:therapeutic use; D006801:Humans; D007783:Lactones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010919:Placebos; D010972:Platelet Activating Factor / Q000037:antagonists & inhibitors*; D010980:Platelet Membrane Glycoproteins / Q000187:drug effects*; D011446:Prospective Studies; D011479:Protamines / Q000627:therapeutic use; D011651:Pulmonary Artery / Q000187:drug effects; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D011956:Receptors, Cell Surface; D043562:Receptors, G-Protein-Coupled; D013599:Systole; D014655:Vascular Resistance / Q000187:drug effects; D016277:Ventricular Function, Left / Q000187:drug effects; D016278:Ventricular Function, Right / Q000187:drug effects
D004224:Diterpenes; D005343:Fibrinolytic Agents; D046934:Ginkgolides; D006494:Heparin Antagonists; D007783:Lactones; D010919:Placebos; D010972:Platelet Activating Factor; D010980:Platelet Membrane Glycoproteins; D011479:Protamines; D011956:Receptors, Cell Surface; D043562:Receptors, G-Protein-Coupled; C039351:platelet activating factor receptor; C045856:ginkgolide B