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Ann Thorac Surg 2002;74:1167-1172
© 2002 The Society of Thoracic Surgeons

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Original article: cardiovascular

Lung protection during total cardiopulmonary bypass by isolated lung perfusion: preliminary results of a novel perfusion strategy

^a Departments of Cardiac Surgery, University Hospital Luebeck, Luebeck, Germany
^b Department For Anesthesiology, University Hospital Luebeck, Luebeck, Germany

Accepted for publication June 5, 2002.

* Address reprint requests to Dr Sievers, Klinik fuer Herzchirurgie, Ratzeburger Allee 160, 23538 Luebeck, Germany
e-mail: sievers{at}medinf.mu-luebeck.de

Background. The present pilot study was conducted to evaluate the effect of isolated short-term lung perfusion during cardiopulmonary bypass (CPB) on inflammatory response and oxygenation.

Methods. A total of 24 patients undergoing elective cardiac surgery with routine CPB were prospectively assigned to three groups. Group I (n = 7), control subjects receiving neither lung perfusion nor ultrafiltration; group II (n = 9), patients undergoing lung perfusion; and group III (n = 8), patients undergoing lung perfusion plus ultrafiltration. Lung perfusion consisted of single-shot hypothermic pulmonary artery perfusion with oxygenated blood. Proteins indicative of leukocyte activation and lung injury were measured in plasma and bronchoalveolar lavage fluid (BALF). The alveolar-arterial oxygen gradient (A-aDO₂) and the oxygenation index (PO₂/FiO₂) were also determined.

Results. Oxygenation values were best preserved in group III, followed by group II. After CPB, elastase-₁-proteinase inhibitor complex had increased in plasma in all groups; in BALF it increased in groups I and II, but not in group III. ₂-Macroglobulin increased significantly in BALF in group I but not in groups II and III.

Conclusions. These preliminary results provide some evidence that single-shot hypothermic lung perfusion with oxygenated blood at the beginning of CPB may have a protective effect on the lungs, especially when combined with ultrafiltration.

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