Lung transplantation with cardiopulmonary bypass exaggerates pulmonary vasomotor dysfunction in the transplanted lung

Abstract

Pulmonary vascular resistance is significantly increased in the transplanted lung. If cardiopulmonary bypass is required, the transplanted lung is reperfused with activated blood elements, which might exacerbate the reperfusion injury. The purpose of this study was to examine the influence of cardiopulmonary bypass on the following mechanisms of pulmonary vasomotor control in a dog model of autologous lung transplantation: (1) endothelium-dependent cyclic guanosine monophosphate–mediated relaxation (response to acetylcholine), (2) endothelium-independent cyclic guanosine monophosphate–mediated relaxation (response to nitroprusside), (3) β–adrenergic cyclic adenosine monophosphate–mediated relaxation (response to isoproterenol). Autologous right lung transplants were performed with ( n = 4 dogs) and without ( n = 5 dogs) bypass. Lungs were stored in cold saline solution (4° C, 3 hours) before reimplantation. Pulmonary vasomotor control mechanisms were studied in isolated pulmonary atrial rings immediately after harvest and 1 hour after implantation. Ten rings were studied in each group at time. Statistical analysis was by analysis of variance. Without bypass, endothelium-dependent cyclic guanosine monophosphate–mediated relaxation and β–adrenergic cycle adenosine monophosphate–mediated relaxation were significantly impaired, although endothelium-independent cyclic guanosine monophosphate–mediated relaxation was not. Use of bypass produced significantly greater impairment of both endothelium-dependent cyclic guanosine monophosphate–mediated relaxation and β-adrenergic cyclic adenosine monophosphate–mediated relaxation. In addition, use of bypass produced significant dysfunction of endothelium-independent cyclic guanosine monophosphate–mediated relaxation as well. We concluded that using cardiopulmonary bypass to perform lung transplantation greatly exaggerates pulmonary vasomotor dysfunction in the transplanted lung. This dysfunction may contribute to significantly higher pulmonary vascular resistance in the transplanted lung if cardiopulmonary bypass is used. (J THORAC CARDIOVASC SURG 1995;109-212-7)