Cytokine and Endothelial Damage in Pulsatile and Nonpulsatile Cardiopulmonary Bypass

Abstract

Recently, several types of centrifugal pumps have been widely used as the main pumps for cardiopulmonary bypass (CPB). However, according to the results of our experimental studies, after cardiogenic shock, pulsatile flow was effective in maintaining the functions and microcirculations of end organs, especially those of the liver and kidney. To estimate the effectiveness of pulsatility during CPB, cytokine and endothelin and other metabolic parameters were measured in clinical pulsatile and nonpulsatile CPB cases. From March to May 1997, CPB was performed in 18 elective cases (14 ischemic and 4 valvular disease). In 9 cases, pulsatile perfusion was achieved by the Jostra HL20, which is a newly developed CPB pump (Group P). A nonpulsatile centrifugal pump was used in 9 patients (Group NP). In both groups, as chemical and metabolic mediators, interleukin-8 (IL-8), endothelin-1 (ET-1), and plasma free hemoglobin were measured before and during CPB, and 0.5, 3, 6, 9, 18 h after weaning from CPB. This pulsatile CPB pump could be very simply and easily controlled and could easily produce pulsatile flow. There were no significant differences in CPB time (CPBT), aortic cross clamp time (ACCT), mean aortic pressure, or pump flow during CPB between the both groups. The ET-1 level of Group P was significantly (p < 0.05) lower than that of Group NP 9 h after CPB weaning. The IL-8 level of Group P also showed a lower value than that of Group NP. As for plasma free hemoglobin, there were no significant differences between the groups. These results suggested that even in conventional CPB, pulsatility was effective to reduce endothelial damage and suppress cytokine activation. It may play a important role in maintaining the functions and microcirculations of end organs during CPB.

Off-pump coronary artery bypass surgery versus standard linear or pulsatile cardiopulmonary bypass: endothelial activation and inflammatory response

“…Both the CPB groups showed peak secretion of IL-10 at time 2, although levels were significantly higher in the PCPB group versus the LCPB group at times 2 and 3. These data support previous reports of greater anti-inflammatory marker release with the use of pulsatile perfusion during CPB [10,12], albeit with different pathophysiological mechanisms in different experimental settings. Our data also confirm in vitro findings that maintenance of steady shear stress on endothelial cells preserves up-regulation of the genes controlling anti-inflammatory, antioxidant and anti-thrombotic functions [25].…”

“…CPB is associated with increased release of IL-10 [1], which not only suppresses production of proinflammatory cytokines but also protects reperfused myocardium by limiting neutrophil recruitment [12]. We found significantly higher IL-10 secretion in the two CPB groups than in the OPCABG group, similar to a previous review of randomised and non-randomised studies [24] and a study of conventional CPB-CABG versus OPCABG [20].…”

“…Accordingly, the clinical use of biochemical assays to detect and quantify circulating cytokines and chemokines -the main effectors of inflammatory response -may help increase our knowledge regarding SIRS [1,4]. Despite the extensive literature, however, the mechanisms underlying post-CPB SIRS are not definitely understood, primarily because of extreme differences in inter-group settings in both animal and clinical studies [1][2][3][4][5][6][9][10][11][12]. The literature also lacks studies of endothelial response and cytokine leakage associated with PCPB versus OPCABG.…”

“…The literature also lacks studies of endothelial response and cytokine leakage associated with PCPB versus OPCABG. We considered patients receiving LCPB the 'control' group, against which we measured endothelial activation and cytokine release after induction of pulsatile perfusion [5,6,12] or with avoidance of CPB, as in OPCABG. A significant, systemic endothelial response -as measured by MCP-1 and VEGF release -occurred after all three types of surgery, but it was significantly more pronounced with CPB use.…”

Pulse Push/Pull Hemodialysis: Convective Renal Replacement Therapy

“…Despite controversy, blood pulsation has been accepted to have a benefit during cardiopulmonary bypass, because it achieves greater perfusion to peripheral vessels and end-organs (Dapper et al, 1992, Orime et al, 1999. Furthermore, blood pulsation in a pediatric CRRT 1 animal model was found to deliver adequate performance over a 2-hour period in terms of ultrafiltration rates and cross-filter blood pressure drops (Lopez-Herce et al, 2006, Ruperez et al, 2003.…”