Continuous pulmonary perfusion during cardiopulmonary bypass prevents lung injury in infants

Pulmonary Perfusion With L-Arginine Ameliorates Post-Cardiopulmonary Bypass Lung Injury in a Rabbit Model

“…Consistent with previous studies, we found that pulmonary perfusion could partially ameliorate this phenomenon. This highlights the importance of maintaining pulmonary perfusion during CPB [7][8][9][10]. More importantly, we showed that provision of the NO precursor (L-arginine) together with pulmonary perfusion solution further possessed significant relaxation ability for pulmonary arterial endothelium as compared to perfusion alone.…”

“…Impaired production of NO, a key vasodilator, may be associated with an increased postoperative pulmonary vascular resistance (PVR) and subsequent lung injury. Restoring pulmonary perfusion during CPB had been shown to improve oxygenation value (oxygen index and alveolar-arterial O 2 gradient) in human (infant) studies [7][8][9]. Recently, pulsatile perfusion has been shown to provide better protection as opposed to continuous perfusion in a piglet model [10].…”

Ventilation during Cardiopulmonary Bypass: Impact on Neutrophil Activation and Pulmonary Sequestration

“…Therefore, stopping lung ventilation together with stopping pulmonary artery perfusion during CPB is likely to be an important cause of postoperative lung dysfunction; possible underlying mechanisms may include lung ischemia-reperfusion, atelectasis, and hydrostatic edema [1]. In addition, an animal study and clinical trial of infants undergoing congenital cardiac surgery comparing standard CPB with and without PA perfusion showed less neutrophil sequestration and better preserved pulmonary vascular resistance and gas exchange in those with PA perfusion further supporting the importance of maintaining lung perfusion [10,14].…”

The Importance of Pulmonary Artery Circulation during Cardiopulmonary Bypass

“…An experimental study showed that under conditions of sufficient perfusion pressure, bronchial blood flow reduced when pulmonary artery circulation was obstructed during CPB. 9 Suzuki et al 10 showed that in infants with continuous pulmonary perfusion, leucocyte levels were lower than pre-bypass values at 30 min after declamping and PaO 2 /FiO 2 values were better in the post-operative period. These studies confirm the beneficial effects of pulmonary artery circulation protection.…”