Effects of pulmonary perfusion during cardiopulmonary bypass on lung functions after cardiac operation

Abstract

Background Pulmonary artery perfusion during cardiopulmonary bypass (CPB) is a known but rarely used technique in adult cardiac surgery. In this study, we aimed to investigate biochemical and histopathological effects of pulmonary artery perfusion during CPB on lung functions. Methods Between May 2014 and August 2014, all patients (n = 24) who gave informed consent for participating this study with inclusion criteria were included. Patients undergoing isolated coronary artery bypass grafting were sequentially randomized to conventional CPB (control group, n = 12) and conventional CPB with selective pulmonary artery perfusion (study group, n = 12). Lung functions were monitored using PF ratio, alveolar‐arterial oxygen gradient, and lactate levels. A small sample tissue from the left lung was excised for histopathologic examination. Immunocytochemistry analysis was performed using anti‐rabbit polyclonal vascular endothelial growth factor (VEGF), rabbit polyclonal inducible nitric oxide synthase (i‐NOS), and BCL‐2 antibodies. Results Postoperative course of the patients were uneventful without any clinical outcome differences in terms of cardiopulmonary complications, ventilation time and hospital stay. Pulmonary perfusion group had significantly better oxygenation values after extubation and at postoperative 24‐hour. Electron microscopy examinations revealed better preservation of the alveolar wall integrity with pulmonary perfusion. The intensity of VEGF, i‐NOS, and BCL‐2 antibody expressions in bronchial epithelial cells were more prominent in the pulmonary perfusion group. Conclusions Pulmonary artery perfusion during aortic cross‐clamping provides better oxygenation and preservation of the wall alveolar integrity after coronary artery bypass grafting surgery. This technique can be used as a protective strategy to minimize CPB‐induced lung injury in adult cardiac surgery.

Selective pulmonary artery perfusion revisited

“…In conclusion, we applaud Karacalilar et al 1 for their contribution to such a controversial topic. However, much further research needs to be done before protective pulmonary artery perfusion could be introduced into broader clinical practice.…”

“…Karacalilar et al 1 attempt to further the controversial topic of the role of pulmonary ischemia and ischemia‐reperfusion injury in the pathogenesis of postbypass pulmonary dysfunction. In their small randomized clinical study, they observe that selective pulmonary artery perfusion during cardiopulmonary bypass with oxygenated blood at 220 to 240 mL/minute/m 2 (10% of systemic flows) may mitigate the disruptive inflammatory cascade in alveolar epithelium.…”

Bi-level Positive Airway Pressure Versus Nasal CPAP for the Prevention of Extubation Failure in Infants After Cardiac Surgery

“…Therefore, patients are more likely to experience complications such as alveolar collapse, atelectasis, acute respiratory failure, and pulmonary infection. 22,23 At the same time, during invasive mechanical ventilation, alveolar mechanical ectasia and partial alveolar structure destruction cause lung injury and airway remodeling. [24][25][26] Thus, for this patient population, noninvasive respiratory support is usually required after extubation.…”

Bilevel Positive Airway Pressure Versus Nasal Continuous Positive Airway Pressure for Prevention of Extubation Failure in Infants After Cardiac Surgery: A Randomized Controlled Trial

“…During pulmonary ischemiareperfusion, in ammatory cells in ltrate, pulmonary interstitial exudation increases, and microvilli on the surface of type II alveolar epithelial cells decrease in abundance. Therefore, patients are more likely to have complications such as alveolar collapse, atelectasis, acute respiratory failure, pulmonary infection, and so on [14,15]. At the same time, during invasive mechanical ventilation, alveolar mechanical ectasia and partial alveolar structure destruction cause lung injury and airway remodeling [16][17][18].…”