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Ann Thorac Surg 1992;53:217-226
© 1992 The Society of Thoracic Surgeons

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Articles

Granulocyte sequestration and early failure in the autoperfused heart-lung preparation

Department of Cardiothoracic Surgery and Pediatric Critical Care, Tufts University School of Medicine and New England Medical Center, Boston, Massachusetts, USA

^_* Address reprint requests to Dr Diehl, New England Medical Center, Box 266, 750 Washington St. Boston, MA 02111.

We investigated the role of pulmonary granulocyte sequestration in the development of early failure of the autoperfused working heart-lung preparation. A significant decline in the total circulating leukocyte count in 21 preparations at 60 minutes of perfusion (5.0 to 1.4 x 10³/µL; 28% of baseline; p < 0.001) was observed. Differential cell counts in 14 of these preparations revealed a predominant decrease in granulocyte count (8.7% of baseline) and a moderate decline in lymphocyte count (46% of baseline). In study I, indium 111-labeled autologous granulocytes were injected intravenously into 10 adult New Zealand While rabbits. In group I (n = 5), an autoperfused working heart-lung preparation was harvested and perfused for 60 minutes. In group II (controls, n = 5), the heart-lung block was harvested following 60 minutes of in situ perfusion. Organ blocks were imaged before and after saline flush. There was a significant decline in granulocyte counts at 60 minutes of perfusion in group I versus no change in group II (I, 2.3 ± 0.4 to 0.3 ± 0.1; p < 0.01; II, 1.7 ± 0.2 to 2.3 ± 0.5; not significant; x10³/µL ± standard error of the mean). Postflush lung activity was significantly increased in group I versus group II (I, 3,751 ± 566; II, 1,867 ± 532; p < 0.05; counts ± standard error of the mean). In study II, 15 autoperfused preparations were divided into two groups. Group I (n = 10) preparations were controls. Group II (n = 5) animals were depleted of leukocytes by pretreating with nitrogen mustard. Group I (controls) produced a bimodal survival distribution (Ia, 8.2 ± 1.0) Ib, 26.4 ± 2.0; hours ± standard error of the mean). Group II survival was significantly longer than that of group Ia and similar to that of group Ib (II, 25.3 ± 2.2; p < 0.01 versus group Ia, not significant versus group Ib; hours ± standard error of the mean). Hemodynamic profiles for group II closely paralleled those of group Ib. In conclusion, pulmonary sequestration of granulocytes occurs early in the autoperfused working heart-lung preparation (within 60 minutes of autoperfusion), and preoperative leukocyte depletion prolongs survival of the autoperfused working heart-lung preparation by eliminating the subset group Ia (short survivors) seen in untreated preparations.