Does aprotinin reduce lung reperfusion damage after cardiopulmonary bypass?

Objective: The role of aprotinin in the prevention of lung reperfusion inju ry was investigated in the patients undergoing cardio-pulmonary bypass (CPB ) for coronary artery bypass grafting (CABG) operations. Methods: The study was planned randomly and prospectively. Two hundred milliliters of physiol ogical saline solution was added to the prime solution of patients in group I (n = 10) whereas, 200 mi aprotinin (Trasylol. Bayer AG) was given to pat ients in group II(n = 10). In order to measure lung tissue malondialdehyde (MDA) levels, glutathion peroxidase (GSH-Px) activity levels and polymorpho nuclear leukocytes (PMNs) numbers, lung tissue samples were taken before CP B and 5 min after removing the cross clamp. In addition, alveolo-arterial o xygen difference (AaDO(2)) for tissue oxygenation was calculated by obtaini ng arterial blood gas samples. Results: MDA levels before CPB increased fro m 41.72 +/- 21.00 nmol/g tissue to 66.71 +/- 13.44 nmol/g tissue in group I and from 43.44 +/- 5.16 nmol MDA/g tissue to 53.22 +/- 10.95 nmol MDA/g ti ssue in group II after cross clamp removal (P = 0.001 and P = 0.021, respec tively). The increase in group LI was found to be significantly lower than group I (P = 0.048). With the initiation of reperfusion. GSH-Px activity de creased in group I from 3.05 +/- 0.97 to 2.31 +/- 0.46 U/mg protein (P = 0. 015) whereas GSH-P,: activity in group II decreased from 3.18 +/- 1.01 to 2 .74 +/- 0.81 U/mg protein (P = 0.055). This decrease in the group II was le ss than group I (P = 0.049), AaDO(2) significantly increased in the group I and II (P = 0.012 and P = 0.020, respectively), but elevation in the group I was significant than in the Group IT (P = 0.049). In histopathological e xamination: it was observed that neutrophil counts in the lung parenchyma r ose significantly following removal of cross clamp in both groups (P = 0.00 1). The increase in group I was significantly larger than in group II (P = 0.050). Conclusion: Results represented in our study indicate that addition of aprotinin (2 million units) into the prime solution during CPB can redu ce lung reperfusion injury. (C) 2000 Elsevier Science B.V. All rights reser ved.