Thorac Cardiovasc Surg 2000; 48(2): 86-92
DOI: 10.1055/s-2000-9874
Original Cardiovascular
© Georg Thieme Verlag Stuttgart · New York

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

G. P. Eisng1 , H. Schad1 , W. Heimisch1 , C. Gippner-Steppert2 , M. Jochum2 , S. L. Braun1 , N. Mendler1 , H. Meisner1 , R. Lange1
  • 1German Heart Center Munich, Technical University of Munich
  • 2Department of Clinical Chemistry and Clinical Biochemistry, Ludwig-Maximilians-University Munich, Germany
Further Information

Publication History

February 25, 1999

Publication Date:
31 December 2000 (online)

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.

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

References

  • 1 Westaby S. Organ dysfunction after cardiopulmonary bypass. A systemic inflammatory reaction initiated by the extracorporeal circuit.  Int Care Med.. 1987;  13 89-95
  • 2 Casey L C. Role of cytokines in the pathogenesis of cardiopulmonary-induced multisystem organ failure.  Ann Thorac Surg.. 1993;  56 (5 Suppl) 92-6
  • 3 Hall R I, Smith M S, Rocker G. The systemic inflammatory response to cardiopulmonary bypass: Pathopysiological, Therapeutic, and Pharmacological Considerations.  Anesth Analg.. 1997;  85 766-82
  • 4 Royston D. The inflammatory response and extracorporeal circulation.  J Cardioth Vasc Anesth.. 1997;  11 341-54
  • 5 Seghaye M C, Grablitz R G, Duchateau J. et al . Inflammatory reaction and capillary leak syndrome related to cardiopulmonary bypass in neonates undergoing cardiac operations.  J Thorac Cardiovasc Surg.. 1996;  112 687-97
  • 6 Elliott M. Ultrafiltration and modified ultafiltration in pediatric open heart operations.  Ann Thorac Surg.. 1993;  56 1518-22
  • 7 Finn A, Naik S, Klein N, Levinsky R J, Strobel S, Elliott M. Interleukin-8 release and neutrophil degranulation after pediatric cardiopulmonary bypass.  J Thorac Cardiovasc Surg.. 1993;  105 234-41
  • 8 Journois D, Pouard P, Greeley W J, Mauriat P, Vouhe P, Safran D. Hemofiltration during cardiopulmonary bypass in pediatric cardiac surgery.  Anesth.. 1994;  81 1181-9
  • 9 Hagl S, Heimisch W, Erben R, Franklin D, Sebening F. Ultraschallverfahren zur direkten Erfassung der regionalen Myokardfunktion.  Thoraxchirurgie.. 1975;  23 291-7
  • 10 Geiger R, Sokal S, Siebeck M, Hoffmann H, Trefz G. Determination of leukocyte elastase-inhibitor complexes and leukocyte neutral proteinase inhibitor by enzyme immunoassays.  J Clin Chem Clin Biochem.. 1988;  26 605-9
  • 11 Schad H, Haider M, Brechtelsbauer H. Bestimmung des Plasmavolumens mit Indocyaningrün.  Anaesthesist.. 1987;  36 608-14
  • 12 Nürnberger W, Göbel U, Stannigel H, Eisele B, Janssen A, Devlos U. C1-inhibitor concentrate for sepsis-related capillary leak syndrome.  Lancet.. 1992;  339 990
  • 13 Eisele B, Rode M, Delvos U. Capillary lenk-Syndrom: Substitution mit C1 Inhibitor.  Die gelben Hefte.. 1994;  34 152
  • 14 Ballmer P E, Ochsenbein A F, Schutz-Hofmann S. Transcapillary escape rate of albumin positively correlates with albumin concentration in acute but not in chronic inflammatory disease.  Metabolism.. 1994;  43 697-705
  • 15 Plötz F B, van Oeveren W, Barlett R H, Wildevuur C RH. Blood activation during neonatal extracorporeal life support.  J Thorac Cardiovasc Surg.. 1993;  105 823-32
  • 16 Schüpbach R, Pappova E, Schilt W, Lundsgaard-Hansen P. Influence of oncotic pressure during cardiopulmonary bypass on tissue edema, metabolic acidosis and renal function.  In: Hagl S, Klövekorn WP, Mayr N, Sebening F, eds. Thirty Years of Extra-corporeal Circulation. 1984: 247-53
  • 17 Wassermann K, Mayerson H S. Mechanism of plasma protein changes following saline infusions.  Am J Physiol.. 1952;  170 1-10
  • 18 Hennein H A, Ebba H, Rodriguez J L. et al . Relationship of the proinflammatory cytokines to myokardial ischemia and dysfunction after uncomplicated coronary revascularisation.  J Thorac Cardiovasc Surg.. 1994;  108 626-35
  • 19 Schad H. Physiologie der Lymphbildung und der Lymphströmung.  Phlebol.. 1996;  25 213-21
  • 20 Wolfer R S, Bishop G G, Burdett M G. et al . Extravascular fluid uptake during cardiopulmonary bypass in hypertensive dogs.  Ann Thorac Surg.. 1994;  57 974-80
  • 21 Mehlhorn U, Allen S J, Davis K L, Geissler H J, Waters R D, de Vivie E R. Increasing colloid osmotic pressure of cardiopulmonary bypass prime and normothermic blood cardioplegia minimizes myocardial oedema and prevents cardiac dysfunction.  Cardiovasc Surg.. 1998;  6 274-81
  • 22 Mehlhorn U, Davis K L, Burke E L, Adams G, Laine G A, Allen S J. Impact of cardiopulmonary bypass and cardioplegic arrest on myocardial lymphatic function.  Am J Physiol.. 1995;  268 H178-83
  • 23 Tassani P, Richter J A, Eising G P. et al . Influence of combined zero-balanced and modified ultrafiltration on the systemic inflammatory response during coronary artery bypass grafting.  J Cardiothorac Vasc Anesth.. 1999;  13 285-91
  • 24 Ungerleider R M. Effects of Cardiopulmonary bypass and use of modified ultrafiltration.  Ann Thorac Surg.. 1998;  65 35-9

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

Dr. G. P. Eising

Klinik für Herz- und Gefäßchirurgie Deutsches Herzzentrum München

Lazarettstrasse 36 80636 München Germany

Fax: Fax +49-89-1218-4113

Email: E-mail: eising@dhm.mhn.de

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