Chinese Journal of Tissue Engineering Research ›› 2012, Vol. 16 ›› Issue (18): 3267-3271.doi: 10.3969/j.issn.1673-8225.2012.18.009

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Lung protective mechanism of mitral valve replacement with beating-heart via mild hypothermic cardiopulmonary bypass

Xie Xiao-yong1, He Wei2, Zheng Bao-shi2, Feng Xu2, Zhou Tao2, Ye Shi-gao2, Feng Zhen-bo1   

  1. 1Guangxi Medical University, Nanning  530021, Guangxi Zhuang Autonomous Region, China; 2Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning  530021, Guangxi Zhuang Autonomous Region, China
  • Received:2011-10-14 Revised:2011-12-18 Online:2012-04-29 Published:2012-04-29
  • Contact: Feng Zhen-bo, Doctor, Professor, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
  • About author:Xie Xiao-yong☆, Doctor, Associate professor, Associate chief physician, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China xiexiaoyong_xxy@yahoo.com.cn

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Abstract:

BACKGROUND: Mitral valve replacement on beating-heart with mild hypothermic cardiopulmonary bypass (CPB) can lessen pulmonary injury after operation, which is relative to its lightening accumulation of polymorphonuclear neutrophil in lung and reducing the serum levels of tumor necrosis factor α and interleukin-8. But other mechanism of its lung protection should research further.
OBJECTIVE: To further explore the lung protective mechanism of mitral valve replacement with beating-heart with mild hypothermic CPB.
METHODS: A total of 40 patients underwent mitral valve replacements which were randomly divided into experimental group and control group. Patients in the experimental group were performed with the operation on beating-heart with mild hypothermic CPB, while the patients in the control group received the operation on arrested heart with moderate hypothermia CPB. The protein expression level of nuclear factor-кB in lung tissue and positive percentage of adhesion molecule CD11b/CD18 in blood was detected after opening chest and 30 minutes after CPB. The serum level of Neutrophil elastase was measured before CPB, 30 minutes during CPB, at the end of CPB and 3, 6 and 12 hours after CPB. Arterial blood gas analysis was preformed and respiratory index was calculated before CPB, at the end of CPB and 1 and 8 hours after CPB.
RESULTS AND CONCLUSION: The protein expression level of nuclear factor-кB in lung tissue and positive percentage of CD11b/CD18 in blood of two groups was increased significantly at 30 minutes after CPB (P < 0.01), but the levels in the control group were higher than that in the experimental group (P < 0.05). The serum levels of Neutrophil elastase in two groups were increased significantly at 30 minutes during CPB, at the end of CPB, 3 and 6 hours after CPB (P < 0.01, P < 0.05), but the level in the control group was higher than that in the experimental group (P < 0.01, P < 0.05). The level of respiratory index in two groups was significantly increased at the end of CPB, 1 and 8 hours after CPB (P < 0.01, P < 0.05), but the level in the experimental group was significantly lower than that in the control group (P < 0.05). It indicates that mitral valve replacement on beating-heart with mild hypothermic cardiopulmonary bypass can reduce the lung injury through the inhibition of nuclear factor-кB activity, decreasing the expression of CD11b/CD18 on the surface of neutrophils and reduce the release of neutrophils.

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