title: Effect of cytokine hemoadsorption on brain death-induced ventricular dysfunction in a porcine model.
abstract: OBJECTIVE
  In an effort to expand the cardiac donor pool, we tested the hypothesis that hemoadsorption of cytokines attenuates brain death-induced ventricular dysfunction.
  
  
  METHODS
  Eighteen Yorkshire pigs (50-60 kg) were instrumented with a left ventricular conductance catheter. Cytokine expression, preload recruitable stroke work, and the diastolic relaxation constant tau were measured at baseline and at hourly intervals for 6 hours after induction of brain death by intracranial balloon inflation (brain death, n = 6) or sham operation (control, n = 6). In a third group (brain death + hemoadsorption, n = 6), 3 hours after induction of brain death, animals were placed on an extracorporeal circuit containing a cytokine-hemoadsorption device for the remaining 3 hours of the experiment. Myocardial water content was measured after the animals were killed.
  
  
  RESULTS
  Six hours after induction of brain death, tumor necrosis factor and interleukin-6 were highest in the brain death group (106 ± 13.1 pg/mL and 301 ± 181 pg/mL, respectively), lowest in controls (68.3 ± 8.55 pg/mL and 37.8 ± 11 pg/mL, respectively), and intermediate in the brain death + hemoadsorption group (81.2 ± 35.2 pg/mL and 94.6 ± 20 pg/mL, respectively). Compared with controls, preload recruitable stroke work was significantly reduced in the brain death group 4 hours after the induction of brain death and was 50% of baseline by 5 hours. In the brain death + hemoadsorption group, preload recruitable stroke work was relatively preserved at 80% of baseline at similar time points. Tau remained unchanged in the control and brain death + hemoadsorption groups, whereas in the brain death group it was significantly elevated versus baseline 5 (139.3% ± 21.5%) and 6 (172% ± 16.1%) hours after induction of brain death. Myocardial water content was significantly greater in the brain death group than in the other 2 groups.
  
  
  CONCLUSIONS
  Hemoadsorption of cytokines using an extracorporeal circuit attenuates brain death-induced ventricular dysfunction in a porcine model. Improvement in function generally correlates with trends in cytokine expression, but this relationship requires further investigation.
authors.affiliation: Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, Wash, USA.
authors.forename: Krasimira M
authors.initials: KM
authors.lastname: Mikhova
authors.forename: Creighton W
authors.initials: CW
authors.lastname: Don
authors.forename: Michael
authors.initials: M
authors.lastname: Laflamme
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.forename: Michael S
authors.initials: MS
authors.lastname: Mulligan
authors.forename: Edward D
authors.initials: ED
authors.lastname: Verrier
authors.forename: David G
authors.initials: DG
authors.lastname: Rabkin
mesh_terms: D000818:Animals; D001706:Biopsy; D001926:Brain Death; D006328:Cardiac Catheterization; D016207:Cytokines / Q000097:blood*; D003971:Diastole; D004195:Disease Models, Animal; D015199:Extracorporeal Membrane Oxygenation; D006382:Hemadsorption; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D013318:Stroke Volume; D034421:Sus scrofa; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control*; D016277:Ventricular Function, Left; D017725:Ventricular Pressure
chemical_list: D016207:Cytokines; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha