The protective effect of pulmonary artery infusion with HTK solution on the lungs during prolonged cardiopulmonary bypass surgery

Abstract

Background

Studies have proved that artery infusion during CPB operations can reduce lung injury led by CPB surgery. This study was undertaken to investigate the effects of HTK solution infusion on pulmonary injury during prolonged CPB.

Methods

Based on the complexity of the surgery, 18 of 55 patients were divided into Group A, whose CPB time would be less than 180 min, The patients whose CPB time was estimiated more than 180 min were randomly divided in Group H and Group C, patients in Group H recieved pulmonary artery infusion with 4°C HTK solution during aortic cross-clamping while Group C underwent traditional procedures. Lung function was assessed by comparing postoperative recovery conditions, respiratory function, inflammatory response and pathological examination. Blood samples were collected from all patients at the following time points: before the start of CPB (T0), 1 hour after aortic declamping (T1), 2 hours (T2), 6 hours (T3), 12 hours (T4), and 24 hours (T5). The levels of tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) were measured in these samples.

Results

Extubation time, ICU and the postoperative hospital stay were shorter in the Group A and Group H (p < .05). There was a significant increase of TNF-α from T2 to T4 in Group C (p < .05). The level of IL-6 in Group C increased significantly from T1 to T5 (p < .05). Compared to Group H, the mean value of TNF-α increased from T1 to T4 while IL-6 increased from T4 to T5 in Group C (p < .05) Inflammatory response was more severe when the CPB time exceeds 180 minutes, so did the clinic outcomes.

Conclusions

Pulmonary artery infusion with HTK solution is a safe procedure in cardiac surgery with long term CPB time. It can be used to alleviate lung injury in cardiac surgery especially when the CPB time exceeds 180 minutes.