Effect of Cardiopulmonary Bypass and Hemofiltration on Plasma Cytokines and Protein Leakage in Pigs[1]

Background: The hypothesis that an inflammatory process during and after cardiopulmonary bypass (CPB) impairs hemodynamics and causes increased capillary protein leakage and that this is possibly ameliorated by hemofiltration (HF) was tested. Method: 26 anesthetized pigs were subjected to 120 min CPB (90 min cardioplegia followed by 30 min reperfusion, combined with conventional and modified HF in 13 animals). Hemodynamics, leukocytes, cytokines (IL-1ra, IL-8, IL-10, TNF-α), LNPI, plasma protein, and the half-life of i.v. injected Evans Blue (t/2) were assessed before and after CPB. Results: CPB was followed by depression of left ventricular function and activation of inflammatory mediators. Although a slight elimination of some inflammatory mediators occurred, HF did neither improve cardiac function nor reduce the inflammatory process. Plasma protein was lost during CPB and hemofiltration by protein trapping to the surfaces of the CPB system, by filtration across the hemofilter, and by increased microvascular filtration (solvent drag). The latter was probably due to an increased filtration pressure in consequence of the reduction of plasma colloid osmotic pressure by the crystalloid primed CPB. t/2 did not indicate an increased microvascular protein leakage after CPB. Conclusion: Hemofiltration is ineffective in improving cardiac function or reducing the inflammatory response of CPB in the pig model.

Cardiopulmonary bypass - Systemic inflammatory response syndrome - Capillary leak syndrome - Hemofiltration - Pig

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1 Presented in part at the 28^th Annual Meeting of the German Society for Thoracic and Curdiovascular Surgery, Dresden, February 1999