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The Journal of Cardiovascular Surgery 1999 August;40(4):487-94

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Extracorporeal circulation does not induce intra-alveolar release of Endothelin 1, but only a modest overproduction in pulmonary circulation

Antonelli M., Letizia C.*, Tritapepe L., Raponi G. M.**, Ghezzi M. C.**, Menichetti A., Ruvolo G.***, Riccioni L., DeBlasi R. A.

From the Department of Anesthesiology and Intensive Care, * IVst Chair of Medical Pathology, ** 1st Chair of Clinical Microbiology, *** Deparment of Heart Surgery La Sapienza University, Rome, Italy


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Objective. To inves­ti­gate wheth­er ECC may pro­duce region­al lib­er­a­tion of inflam­ma­to­ry medi­a­tors ­capable of induc­ing vas­cu­lar ­effects and ­organ dam­age. Experimental ­design: randomized, com­par­a­tive ­study.
Setting: cardiac sur­gery depart­ment in a University hos­pi­tal. Patients: fifteen ­patients under­go­ing cor­o­nary ­artery ­bypass graft­ing (­CABG, ­group A) and ten ­patients oper­at­ed for ­infra­renal abdom­i­nal aor­tic aneu­rysm (con­trols, ­group B) ­have ­been stud­ied. Measures: levels of Interleukin 1β (IL1), Tumor Necrosis Factor α (TNF), Interleukin 6 (IL6), and Endothelin 1 (ET1) ­were meas­ured in pul­mo­nary cap­il­lary, arte­ri­al, and ­venous ­blood and in bron­choal­ve­o­lar lav­ag­es (BAL) ­before, dur­ing and ­after extra­cor­po­real cir­cu­la­tion (ECC) or sur­gi­cal inter­ven­tion.
Results. TNF-α (nev­er >35 pg/ml) and IL1β (­range 20-300 pg/ml) val­ues did not ­change ­over ­time for ­both ­groups. IL6 con­cen­tra­tions in all sam­ples of ­group A ­increased ­between ­five and twen­ty ­fold, dur­ing and ­after ECC (­from 3-5 pg/ml up to 240 pg/ml, p<0.001). This ­trend was sim­i­lar in con­trols ­after sur­gi­cal ­stress. Endothelin 1 was ­always unde­tect­able in the BAL ­fluid, ­with a mod­est, but sig­nif­i­cant ­increase in pul­mo­nary cap­il­lary ­blood of ­group A, ­after ECC, (­from 11±4 pg/ml to 18±5 pg/ml, p<0.001). This incre­ment cor­re­lat­ed ­well ­with the PVR ­increase, but was tran­sient and ­after 24 ­hours, ET1 val­ues ­returned to base­line lev­els. Mean val­ues of ET1 ­increased ­also in con­trols, but not sig­nif­i­cant­ly.
Conclusions. ECC may ­induce ET1 lib­er­a­tion in pul­mo­nary cir­cu­la­tion ­with tran­sient pul­mo­nary vaso­con­stric­tion, but wih­out ­intra-alveo­lar ­release, or ­lung dam­age. Augmented con­cen­tra­tions of IL6 prob­ably ­express a ­response to sur­gi­cal pro­ce­dure rath­er ­than an ­effect exclu­sive­ly relat­ed to ECC.

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