Lung protection during total cardiopulmonary bypass by isolated lung perfusion: preliminary results of a novel perfusion strategy.
BACKGROUND
The present pilot study was conducted to evaluate the effect of isolated short-term lung perfusion during cardiopulmonary bypass (CPB) on inflammatory response and oxygenation.


METHODS
A total of 24 patients undergoing elective cardiac surgery with routine CPB were prospectively assigned to three groups. Group I (n = 7), control subjects receiving neither lung perfusion nor ultrafiltration; group II (n = 9), patients undergoing lung perfusion; and group III (n = 8), patients undergoing lung perfusion plus ultrafiltration. Lung perfusion consisted of single-shot hypothermic pulmonary artery perfusion with oxygenated blood. Proteins indicative of leukocyte activation and lung injury were measured in plasma and bronchoalveolar lavage fluid (BALF). The alveolar-arterial oxygen gradient (A-aDO2) and the oxygenation index (PO2/FiO2) were also determined.


RESULTS
Oxygenation values were best preserved in group III, followed by group II. After CPB, elastase-alpha1-proteinase inhibitor complex had increased in plasma in all groups; in BALF it increased in groups I and II, but not in group III. Alpha2-macroglobulin increased significantly in BALF in group I but not in groups II and III.


CONCLUSIONS
These preliminary results provide some evidence that single-shot hypothermic lung perfusion with oxygenated blood at the beginning of CPB may have a protective effect on the lungs, especially when combined with ultrafiltration.
Sievers
Hans-H
HH
Department of Cardiac Surgery, University Hospital Luebeck, Germany. sievers@medinf.mu-luebeck.de
Freund-Kaas
Cordula
C
Eleftheriadis
Sawas
S
Fischer
Thomas
T
Kuppe
Hermann
H
Kraatz
Ernst G
EG
Bechtel
J F Matthias
JF
D000328:Adult; D000368:Aged; D001798:Blood Proteins / Q000032:analysis; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D019272:Leukocyte Elastase / Q000097:blood; D008168:Lung / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010477:Perfusion / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D014462:Ultrafiltration; D014764:Viral Proteins / Q000032:analysis; D000515:alpha 1-Antitrypsin
C449194:BALF1 protein, Human herpesvirus 4; D001798:Blood Proteins; D014764:Viral Proteins; D000515:alpha 1-Antitrypsin; C037741:alpha 1-antitrypsin-leukocyte elastase complex; D019272:Leukocyte Elastase; D010100:Oxygen