Evidence for Inflammatory Responses of the Lungs During Coronary Artery Bypass Grafting With Cardiopulmonary Bypass

doi:10.1378/chest.119.1.31

Chest

Volume 119, Issue 1, January 2001, Pages 31-36

https://doi.org/10.1378/chest.119.1.31 Get rights and content

Objective:

The occurrence of a systemic inflammatoryreaction during cardiac surgery with cardiopulmonary bypass (CPB) hasbeen well established, and the heart itself has been shown to releaseinflammatory mediators after ischemia. The hypothesis of the presentstudy was that the lungs are also a site of inflammatory responsesduring early reperfusion.

Methods:

In 20 consecutivepatients undergoing coronary artery bypass grafting, blood wassimultaneously drawn from the right atrium (RA) and the pulmonary vein(PV) before CPB and at 1 min, 10 min, and 20 min of reperfusion. Thelevels of interleukin (IL)-6, IL-8, IL-10, and tumor necrosis factor(TNF)-α were determined, as well as the adhesion molecules CD41 and, CD62 on platelets and CD11b and CD41 on leukocytes. As a measure of thepulmonary release, ratios of PV and RA levels were calculated.

Results:

Before CPB, the concentrations of cytokines tendedto be lower in the PV compared with the RA. At 1 min of reperfusion, nosignificant concentration increases were found in the PV. At 10 min ofreperfusion, the PV/RA ratio (mean ± SEM) for IL-6 was2.06 ± 0.37 and 1.24 ± 0.15 for IL-8 (p = 0.02 and p = 0.04,respectively, compared with the pre-CPB ratios of 0.89 ± 0.4 and0.99 ± 0.2). At 20 min of reperfusion, PV/RA ratios for IL-6(1.95 ± 0.37) and IL-10 (0.99 ± 0.4) were higher than before CPB(0.89 ± 0.04, p = 0.05 and 0.85 ± 0.06, p = 0.03,respectively). Adhesion molecule counts on platelets andpolymorphonuclear neutrophils (PMNs) tended to be higher in the PV thanin the RA before CPB. At 1 min of reperfusion, the PV/RA ratio of CD41on monocytes (0.89 ± 0.04) and of CD41 on PMNs (1.05 ± 0.05) wasless than before CPB (1.24 ± 0.08, p = 0.0002 and 1.55 ± 0.14,p = 0.0002). At 10 min and 20 min of reperfusion, similar changeswere found.

Conclusions:

The observed changes indicatean inflammatory response of the lungs. Proinflammatory cytokines areincreased in pulmonary venous blood. At the same time, activated bloodcells are retained in the pulmonary circulation. This may contribute topulmonary dysfunction almost routinely observed after, CPB.

Section snippets

Patients

In 20 consecutive patients undergoing CABG, blood wassimultaneously drawn from the right atrium (RA) and the right upperpulmonary vein (PV) before CPB (after opening of the pericardium) andat 1 min, 10 min, and 20 min of reperfusion after release of the aorticcross-clamp. Exclusion criteria were unstable angina, myocardialinfarction within 14 days before cardiac surgery, COPD, diabetesmellitus, and any systemic inflammatory disease. For blood samplingfrom the RA, the central part of a Swan-Ganz

Results

After termination of CPB, the mean oxygen saturation was98.9 ± 0.3%, and mean Po₂ and, Pco₂ were 245 ± 28 mm Hgand 37 ± 1 mm Hg, respectively. Before surgery, 18 of 20 patientswere receiving oral nitrates, 11 patients were treated with aβ-blocking agent, and 7 patients were receiving anangiotensin-converting enzyme inhibitor.

Absolute results of cytokines and adhesion molecules are listed inTable 1. Absolute results of cytokine andadhesion molecule measurements at all reperfusion time points

Discussion

In the present study, a significant concentration increase of theproinflammatory cytokines IL-6 and IL-8 in pulmonary vein was observedduring reperfusion in patients undergoing CABG with CPB. At the sametime, activated platelet/leukocyte coaggregates, identified by thecarriage of the platelet adhesion molecule CD41, are retained in thepulmonary circulation compared with pre-CPB. In contrast to IL-6, IL-8,and IL-10, the concentrations of TNF-α in blood from the RA and PVwere not different. The

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This work was performed at the German Heart Center Munich, Departmentof Cardiothoracic Surgery.

This work was supported by the Deutsche Forschungsgemeinschaft(MA 1731/3–2).

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Chest

Clinical InvestigationsSURGERYEvidence for Inflammatory Responses of the Lungs During Coronary Artery Bypass Grafting With Cardiopulmonary Bypass

Objective:

Methods:

Results:

Conclusions:

Section snippets

Patients

Results

Discussion

Initiation of white cell activation during cardiopulmonary bypass: cytokines and receptors

J Cardiovasc Pharmacol

Platelet and neutrophil activation during cardiac surgical procedures: impact of cardiopulmonary bypass

Ann Thorac Surg

Human cytokine responses to cardiac transplantation and coronary artery bypass grafting

J Thorac Cardiovasc Surg

Amplification of the inflammatory response: adhesion molecules associated with platelet/white cell responses

J Cardiovasc Pharmacol

Acute cardiac inflammatory responses to postischemic reperfusion during cardiopulmonary bypass

Cardiovasc Res

Altered pulmonary microvascular reactivity after total cardiopulmonary bypass

J Thorac Cardiovasc Surg

Parameters of pulmonary injury after total or partial cardiopulmonary bypass

Circulation

Thromboxane production in human lung during cardiopulmonary bypass: beneficial effect of aspirin?

Ann Thorac Surg

Acute effects of sodium nitroprusside on systemic and cardiac inflammatory response during coronary artery bypass surgery

Ann Thorac Surg

Clinical Investigations
SURGERY
Evidence for Inflammatory Responses of the Lungs During Coronary Artery Bypass Grafting With Cardiopulmonary Bypass