title: Controlled lung reperfusion to reduce pulmonary ischaemia/reperfusion injury after cardiopulmonary bypass in a porcine model.
abstract: OBJECTIVE
  Ischaemia/reperfusion (I/R) injury of the lungs contributes to pulmonary dysfunction after cardiac surgery with cardiopulmonary bypass (CPB), leading to increased morbidity and mortality of patients. This study investigated the value of controlled lung reperfusion strategies on lung ischaemia-reperfusion injury in a porcine CPB model.
  
  
  METHODS
  Pigs were subjected to routine CPB for 120 min with 60 min of blood cardioplegic cardiac arrest (CCA). Following CCA, the uncontrolled reperfusion (UR, n = 6) group was conventionally weaned from CPB. Two groups underwent controlled lung reperfusion strategies (CR group: controlled reperfusion conditions, n = 6; MR group: controlled reperfusion conditions and modified reperfusate, n = 6) via the pulmonary artery before CPB weaning. Sham-operated pigs (n = 7) served as controls. Animals were followed up until 4 h after CPB. Pulmonary function, haemodynamics, markers of inflammation, endothelial injury and oxidative stress as well as morphological lung alterations were analysed.
  
  
  RESULTS
  CPB (UR group) induced deterioration of pulmonary function (lung mechanics, oxygenation index and lung oedema). Also, controlled lung reperfusion groups (CR and MR) presented with pulmonary dysfunction after CPB. However, compared with UR, controlled lung reperfusion strategies (CR and MR) improved lung mechanics and reduced markers of oxidative stress, but without alteration of haemodynamics, oxygenation, inflammation, endothelial injury and lung morphology. Both controlled reperfusion groups were similar without relevant differences.
  
  
  CONCLUSIONS
  Controlled lung reperfusion strategies attenuated a decrease in lung mechanics and an increase in oxidative stress, indicating an influence on CPB-related pulmonary injury. However, they failed to avoid completely CPB-related lung injury, implying the need for additional strategies given the multifactorial pathophysiology of postoperative pulmonary dysfunction.
authors.affiliation: Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany ingo.slottosch@uk-koeln.de.
authors.forename: Ingo
authors.initials: I
authors.lastname: Slottosch
authors.affiliation: Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany Department Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Liakopoulos
authors.affiliation: Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany.
authors.forename: Elmar
authors.initials: E
authors.lastname: Kuhn
authors.affiliation: Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Deppe
authors.affiliation: Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany.
authors.forename: Alberto
authors.initials: A
authors.lastname: Lopez-Pastorini
authors.affiliation: Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Schwarz
authors.affiliation: Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Neef
authors.affiliation: Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany.
authors.forename: Yeong-Hoon
authors.initials: YH
authors.lastname: Choi
authors.forename: Anja
authors.initials: A
authors.lastname: Sterner-Kock
authors.affiliation: Institute of Anatomy and Cell Biology, University of Giessen, Giessen, Germany.
authors.forename: Kristina
authors.initials: K
authors.lastname: Jung
authors.affiliation: Institute of Anatomy and Cell Biology, University of Giessen, Giessen, Germany Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Mühlfeld
authors.affiliation: Department of Cardiothoracic Surgery, Heartcenter, University Hospital Cologne, Cologne, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D004195:Disease Models, Animal; D019332:Endothelin-1 / Q000097:blood; D006439:Hemodynamics; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008168:Lung / Q000098:blood supply* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D055370:Lung Injury / Q000097:blood / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D008315:Malondialdehyde / Q000097:blood; D018384:Oxidative Stress; D010477:Perfusion / Q000379:methods*; D011654:Pulmonary Edema / Q000503:physiopathology / Q000517:prevention & control; D015427:Reperfusion Injury / Q000097:blood / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D015656:Respiratory Mechanics; D013552:Swine; D013997:Time Factors
chemical_list: D015415:Biomarkers; D019332:Endothelin-1; D018836:Inflammation Mediators; D015850:Interleukin-6; D008315:Malondialdehyde
keywords: Cardiac surgery; Cardiopulmonary bypass; Controlled reperfusion; Lung ischaemia–reperfusion injury; Postoperative lung failure