Lung perfusion during cardiac surgery with cardiopulmonary bypass: is it necessary?
Thirty-two pigs were randomized into group I (aortic cross clamping, antegrade cardioplegia, moderate hypothermia) and group II (normothermia, beating empty heart). Groups were subdivided into subgroups A, B and C, receiving no lung perfusion, perfusion with arterial blood and perfusion with venous blood. Swan-Ganz catheter was used to take mean pulmonary artery pressure which would be used as lung perfusion pressure. Cardiopulmonary bypass (CPB) was established through cannulating aorta and double venae cavae, mechanical ventilation was interrupted and lung perfusion was carried out for 30 min. Blood samples and pulmonary specimens were withdrawn pre- and postoperatively for gasometrical, histological and genic analyses. Postoperative comparison revealed that pulmonary vascular resistance was lower in IC than IA (P=0.01) and it was lower in IIC than IIA (P=0.005). Subgroup IIB had increasing venous oxygen tension (P=0.01) as well as arterial and venous oxygen saturation (P=0.01) compared to IIA. Arterial oxygen saturation was decreased in IIC vs. IIA (P=0.006). Histological differences were observed between subgroups A and B as well as A and C (P=0.003). Lung perfusion during CPB may improve pulmonary hemodynamic performance, optimize gas exchange and maintain cellular integrity.
Gabriel
Edmo Atique
EA
Department of Surgery, Division of Cardiovascular Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil. edag@uol.com.br
Fagionato Locali
Rafael
R
Katsumi Matsuoka
Priscila
P
Santiago Almeida
Ludmila
L
Guerreiro Silva
Ismael
I
Capelozzi
Vera Lúcia
VL
Salerno
Tomas Antonio
TA
Buffolo
Enio
E
D000818:Animals; D001794:Blood Pressure; D002302:Cardiac Output; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002407:Catheterization, Swan-Ganz; D016207:Cytokines / Q000235:genetics; D006324:Heart Arrest, Induced; D006439:Hemodynamics; D008168:Lung / Q000098:blood supply* / Q000473:pathology; D055370:Lung Injury / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D010100:Oxygen / Q000097:blood; D010477:Perfusion / Q000379:methods*; D011651:Pulmonary Artery / Q000503:physiopathology*; D011652:Pulmonary Circulation; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial; D013552:Swine; D014655:Vascular Resistance
D016207:Cytokines; D010100:Oxygen