111 * THE INFLUENCE OF SELECTIVE LUNG PERFUSION ON THE INFLAMMATORY RESPONSE AND CLINICAL OUTCOME OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE UNDERGOING CARDIOPULMONARY BYPASS

Abstract

Objectives: Patients with chronic obstructive pulmonary disease (COPD) undergoing cardiac surgery have a high 30-day mortality risk. Pulmonary dysfunction is frequent in these patients after surgery using cardiopulmonary bypass (CPB). We hypothesize that selective pulmonary perfusion (sPP) leads to reduction of systemic inflammation and to better clinical outcomes. Methods: Fifty-six patients with COPD (FEV1/VC <70%) undergoing cardiac surgery under CPB (coronary artery bypass grafting 76%, valve 24%) were randomized to sPP (venous blood 20degreeC, 4 l) or standard CPB (28/28). Blood samples were obtained before and after CPB at defined time-points (pre-, end-CPB, and 3 h, 24 h, and 48 h postoperatively). Expression of proinflammatory cytokines (IL-1, IL-6, PMN-Elastase, TNF-alpha) was determined by means of ELISA testing. The clinical endpoints were Intensive Care Unit (ICU) stay, time on respirator (TOR) and major adverse cardiac and cerebrovascular events. Repeated-measure analysis of variance was used to assess the differences between/within the groups. Results: Both groups proved comparable for perioperative variables. No differences between the groups were found regarding pro-inflammatory cytokines (P > 0.05 at single time points), although the markers of the inflammatory response increased after CBP (P < 0.05 pre-/24 h). Clinical endpoints were comparable in both groups. However, a trend to shorter TOR (70.8 +/- 154 h/ 110 +/- 199 h) and ICU stay (3.9 +/- 7.7 d/5.5 +/- 9.2 d) was observed in the sPP group. Conclusions: Our preliminary results suggest that single-shot hypothermic lung perfusion with venous blood during CPB may have a protective effect on clinical outcomes of patients with COPD. The influence of sPP upon isolated lung function, as determined by alveolar-arterial oxygen gradient (A-aDO2), oxygenation index (PO2/FiO2) and extravascular lung water needs to be evaluated.