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* From the Department of Cardiothoracic Surgery (Dr. Massoudy), University of Essen, Essen; the Departments of Cardiothoracic Surgery (Dr. Meisner), Laboratory Medicine (Dr. Braun), and Anesthesiology (Dr. Barankay), German Heart Center Munich, Munich; and the Department of Physiology (Drs. Zahler and Becker), University of Munich, Munich, Germany.
Correspondence to: Parwis Massoudy, MD, University of Essen, Department of Cardiothoracic Surgery, Hufelandstr. 55, 45147 Essen; e-mail: parwis.massoudy{at}uni-essen.de
Objective: The occurrence of a systemic inflammatory reaction during cardiac surgery with cardiopulmonary bypass (CPB) has been well established, and the heart itself has been shown to release inflammatory mediators after ischemia. The hypothesis of the present study was that the lungs are also a site of inflammatory responses during early reperfusion.
Methods: In 20 consecutive
patients undergoing coronary artery bypass grafting, blood was
simultaneously drawn from the right atrium (RA) and the pulmonary vein
(PV) before CPB and at 1 min, 10 min, and 20 min of reperfusion. The
levels of interleukin (IL)-6, IL-8, IL-10, and tumor necrosis factor
(TNF)-
were determined, as well as the adhesion molecules CD41 and
CD62 on platelets and CD11b and CD41 on leukocytes. As a measure of the
pulmonary release, ratios of PV and RA levels were calculated.
Results: Before CPB, the concentrations of cytokines tended to be lower in the PV compared with the RA. At 1 min of reperfusion, no significant concentration increases were found in the PV. At 10 min of reperfusion, the PV/RA ratio (mean ± SEM) for IL-6 was 2.06 ± 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 and 0.99 ± 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 and polymorphonuclear neutrophils (PMNs) tended to be higher in the PV than in the RA before CPB. At 1 min of reperfusion, the PV/RA ratio of CD41 on monocytes (0.89 ± 0.04) and of CD41 on PMNs (1.05 ± 0.05) was less 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 changes were found.
Conclusions: The observed changes indicate an inflammatory response of the lungs. Proinflammatory cytokines are increased in pulmonary venous blood. At the same time, activated blood cells are retained in the pulmonary circulation. This may contribute to pulmonary dysfunction almost routinely observed after CPB.
Key Words: adhesion molecules • coronary artery bypass grafting • cytokines • pulmonary circulation
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