The Annals of Thoracic Surgery, Vol 53, 217-226, Copyright © 1992 by The Society of Thoracic Surgeons
Granulocyte sequestration and early failure in the autoperfused heart- lung preparation
CM Genco, RJ Connolly, MB Peterson, EA Bernstein, K Ramberg, X Zhang, RJ Cleveland and JT Diehl
Department of Cardiothoracic Surgery and Pediatric Critical Care, Tufts University School of Medicine, Boston, Massachusetts.
We investigated the role of pulmonary granulocyte sequestration in the
development of early failure of the autoperfused working heart-lung
preparation. A significant decline in the total circulating leukocyte count
in 21 preparations at 60 minutes of perfusion (5.0 to 1.4 x 10(3)/microL;
28% of baseline; p less than 0.001) was observed. Differential cell counts
in 14 of these preparations revealed a predominant decrease in granulocyte
count (8.7% of baseline) and a moderate decline in lymphocyte count (46% of
baseline). In study I, indium 111-labeled autologous granulocytes were
injected intravenously into 10 adult New Zealand White rabbits. In group I
(n = 5), an autoperfused working heart-lung preparation was harvested and
perfused for 60 minutes. In group II (controls, n = 5), the heart-lung
block was harvested following 60 minutes of in situ perfusion. Organ blocks
were imaged before and after saline flush. There was a significant decline
in granulocyte counts at 60 minutes of perfusion in group I versus no
change in group II (I, 2.3 +/- 0.4 to 0.3 +/- 0.1; p less than 0.01; II,
1.7 +/- 0.2 to 2.3 +/- 0.5; not significant; x 10(3)/microL +/- standard
error of the mean). Postflush lung activity was significantly increased in
group I versus group II (I, 3,751 +/- 566; II, 1,867 +/- 532; p less than
0.05; counts +/- standard error of the mean). In study II, 15 autoperfused
preparations were divided into two groups. Group I (n = 10) preparations
were controls. Group II (n = 5) animals were depleted of leukocytes by
pretreating with nitrogen mustard. Group I (controls) produced a bimodal
survival distribution (Ia, 8.2 +/- 1.0; Ib, 26.4 +/- 2.0; hours +/-
standard error of the mean). Group II survival was significantly longer
than that of group Ia and similar to that of group Ib (II, 25.3 +/- 2.2; p
less than 0.01 versus group Ia, not significant versus group Ib; hours +/-
standard error of the mean). Hemodynamic profiles for group II closely
paralleled those of group Ib. In conclusion, pulmonary sequestration of
granulocytes occurs early in the autoperfused working heart-lung
preparation (within 60 minutes of autoperfusion), and preoperative
leukocyte depletion prolongs survival of the autoperfused working
heart-lung preparation by eliminating the subset group Ia (short survivors)
seen in untreated preparations.
