Hypothermic low-flow cardiopulmonary bypass impairs pulmonary and right ventricular function more than circulatory arrest

Jess M. Schultz, Tara Karamlou, Julia Swanson, Irving Shen, Ross M. Ungerleider, J. William Gaynor

Research output: Contribution to journalArticle

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Abstract

Background. Hypothermic circulatory arrest (HCA) is used during surgical treatment of certain congenital heart defects. The possibility of ischemic neurologic injury associated with HCA has led some surgeons to use low-flow cardiopulmonary bypass (CPB) during the hypothermic interval (hypothermic low flow [HLF]). This study investigates the inflammatory response to HCA and HLF, and reports the consequences of this response on pulmonary and right ventricular function. Methods. Piglets (3.1 to 6.6 kg) were cooled to 16° to 18°C using CPB, and randomized: HCA for 60 minutes (n = 7), or HLF (50 cc·kg-1·min-1) for 60 minutes (n = 6). The piglets were rewarmed to 36°C and weaned from CPB. Serum tumor necrosis factor-alpha (TNF-α) concentration, percent lung water, and pulmonary and cardiac function were measured before and after CPB. Results. Tumor necrosis factor-alpha was higher after HLF (2,990.5 ± 884.5 pg/mL), compared with HCA (347.6 ± 89.2 pg/mL; p = 0.03). The percent lung water was higher after HLF (84.8% ± 0.3%) than HCA (82.0% ± 0.4%; p <0.001). The alveolar to arterial oxygen gradient was worse after HLF (457 ± 42 mm Hg) than HCA (285.8 ± 45 mm Hg; p = 0.02). Pulmonary vascular resistance was greater after HLF (36.08 ± 8.28 mm Hg·mL -1·m-2·min-1) than HCA (14.55 ± 3.46 mm Hg·mL-1·m-2·min -1; p = 0.049). The right ventricular pressure waveform peak derivative, corrected for systolic pulmonary artery pressure, was lower after HLF (14.1 ± 1.4 sec-1), than HCA (23.8 ± 2.7 sec -1; p = 0.01). Conclusions. Hypothermic low flow extends exposure to CPB, and is associated with an increased inflammatory response compared with HCA. The greater inflammatory response after HLF may result in substantial nonneurologic morbidity in the postoperative period, demonstrated by pulmonary and right ventricular dysfunction. Interventions that attenuate the inflammatory response to CPB may prevent pulmonary and right ventricular dysfunction after HLF.

Original languageEnglish (US)
Pages (from-to)474-480
Number of pages7
JournalAnnals of Thoracic Surgery
Volume81
Issue number2
DOIs
StatePublished - Feb 2006

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Right Ventricular Function
Cardiopulmonary Bypass
Lung
Right Ventricular Dysfunction
Tumor Necrosis Factor-alpha
Nervous System Trauma
Congenital Heart Defects
Water
Ventricular Pressure
Postoperative Period
Vascular Resistance
Pulmonary Artery
Oxygen
Morbidity
Pressure
Serum

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Hypothermic low-flow cardiopulmonary bypass impairs pulmonary and right ventricular function more than circulatory arrest. / Schultz, Jess M.; Karamlou, Tara; Swanson, Julia; Shen, Irving; Ungerleider, Ross M.; Gaynor, J. William.

In: Annals of Thoracic Surgery, Vol. 81, No. 2, 02.2006, p. 474-480.

Research output: Contribution to journalArticle

Schultz, Jess M. ; Karamlou, Tara ; Swanson, Julia ; Shen, Irving ; Ungerleider, Ross M. ; Gaynor, J. William. / Hypothermic low-flow cardiopulmonary bypass impairs pulmonary and right ventricular function more than circulatory arrest. In: Annals of Thoracic Surgery. 2006 ; Vol. 81, No. 2. pp. 474-480.
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AU - Schultz, Jess M.

AU - Karamlou, Tara

AU - Swanson, Julia

AU - Shen, Irving

AU - Ungerleider, Ross M.

AU - Gaynor, J. William

PY - 2006/2

Y1 - 2006/2

N2 - Background. Hypothermic circulatory arrest (HCA) is used during surgical treatment of certain congenital heart defects. The possibility of ischemic neurologic injury associated with HCA has led some surgeons to use low-flow cardiopulmonary bypass (CPB) during the hypothermic interval (hypothermic low flow [HLF]). This study investigates the inflammatory response to HCA and HLF, and reports the consequences of this response on pulmonary and right ventricular function. Methods. Piglets (3.1 to 6.6 kg) were cooled to 16° to 18°C using CPB, and randomized: HCA for 60 minutes (n = 7), or HLF (50 cc·kg-1·min-1) for 60 minutes (n = 6). The piglets were rewarmed to 36°C and weaned from CPB. Serum tumor necrosis factor-alpha (TNF-α) concentration, percent lung water, and pulmonary and cardiac function were measured before and after CPB. Results. Tumor necrosis factor-alpha was higher after HLF (2,990.5 ± 884.5 pg/mL), compared with HCA (347.6 ± 89.2 pg/mL; p = 0.03). The percent lung water was higher after HLF (84.8% ± 0.3%) than HCA (82.0% ± 0.4%; p <0.001). The alveolar to arterial oxygen gradient was worse after HLF (457 ± 42 mm Hg) than HCA (285.8 ± 45 mm Hg; p = 0.02). Pulmonary vascular resistance was greater after HLF (36.08 ± 8.28 mm Hg·mL -1·m-2·min-1) than HCA (14.55 ± 3.46 mm Hg·mL-1·m-2·min -1; p = 0.049). The right ventricular pressure waveform peak derivative, corrected for systolic pulmonary artery pressure, was lower after HLF (14.1 ± 1.4 sec-1), than HCA (23.8 ± 2.7 sec -1; p = 0.01). Conclusions. Hypothermic low flow extends exposure to CPB, and is associated with an increased inflammatory response compared with HCA. The greater inflammatory response after HLF may result in substantial nonneurologic morbidity in the postoperative period, demonstrated by pulmonary and right ventricular dysfunction. Interventions that attenuate the inflammatory response to CPB may prevent pulmonary and right ventricular dysfunction after HLF.

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