Neutrophils and platelets accumulate in the heart, lungs, and kidneys after cardiopulmonary bypass in neonatal pigs.
OBJECTIVE
Cardiac surgery with cardiopulmonary bypass elicits a systemic inflammatory response. An exaggerated response is associated with organ dysfunction and increased morbidity and mortality.


METHODS
The aim of the present study was to investigate whether the cardiopulmonary bypass procedure in itself results in accumulation of isotope-labeled platelets, polymorphonuclear neutrophils, and fibrinogen at organ levels in neonatal pigs and to monitor changes in organ function.


METHODS
Pediatric cardiopulmonary bypass setup with 60 mins of aortic cross-clamp time and 120 mins of hypothermic cardiopulmonary bypass time.


METHODS
Thirty piglets were allocated to sternotomy alone (sham group, n = 15) or to sternotomy and cardiopulmonary bypass (n = 15).


RESULTS
Isotope-labeled autologous polymorphonuclear neutrophils, platelets, and commercially available fibrinogen were infused, and the specific accumulation at organ level was measured in a gamma counter 4 hrs after termination of cardiopulmonary bypass. Concomitant changes in oxygenation index and cardiac output were registered. Animals exposed to cardiopulmonary bypass showed a significantly higher technetium-99m-polymorphonuclear neutrophil accumulation in the lungs and kidneys, whereas indium-111-platelets accumulated in the heart and kidneys compared with the sham group. There was a significantly larger increase in oxygenation index and significantly larger decrease in cardiac output between the pre- and postcardiopulmonary bypass period in the cardiopulmonary bypass group compared with the sham group.


CONCLUSIONS
The cardiopulmonary bypass procedure without cardiac surgery elicits organ dysfunction in terms of impaired respiratory and hemodynamic function. Platelets and polymorphonuclear neutrophils were entrapped in the heart, lungs, and kidneys of cardiopulmonary bypass animals, indicating that cell accumulation may contribute to the developing organ dysfunction.
Brix-Christensen
Vibeke
V
Department of Anaesthesiology, Aarhus University Hospital, Denmark. brixchr@dadlnet.dk
Tønnesen
Else
E
Hjortdal
Vibeke Elisabeth
VE
Chew
Michelle
M
Flø
Christian
C
Marqversen
Jørgen
J
Hansen
Joachim Frølund
JF
Andersen
Niels Trolle
NT
Ravn
Hanne Berg
HB
D000818:Animals; D000831:Animals, Newborn; D001792:Blood Platelets / Q000378:metabolism*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D005340:Fibrinogen / Q000378:metabolism; D006439:Hemodynamics; D007249:Inflammation / Q000378:metabolism* / Q000503:physiopathology; D007668:Kidney / Q000378:metabolism*; D008168:Lung / Q000378:metabolism*; D009206:Myocardium / Q000378:metabolism*; D009504:Neutrophils / Q000378:metabolism*; D011868:Radioisotopes; D015656:Respiratory Mechanics; D013552:Swine
D011868:Radioisotopes; D005340:Fibrinogen