Pulmonary Perfusion with Oxygenated Blood or Custodiol HTK Solution during Cardiac Surgery for Postoperative Pulmonary Function in COPD Patients

BACKGROUND:

Five to thirty percent of patients undergoing
cardiac surgery present with chronic obstructive pulmonary disease
(COPD) and have a 2- to 10-fold higher 30-day mortality risk.
Cardiopulmonary bypass (CPB) creates a whole body systemic inflammatory
response syndrome (SIRS) that could impair pulmonary function. Impaired
pulmonary function can, however, be attenuated by pulmonary perfusion
with oxygenated blood or custodiol HTK
(histidine-tryptophan-ketoglutarate) solution.

METHODS/DESIGN:

The
Pulmonary Protection Trial (PP-Trial) randomizes 90 patients undergoing
CPB-dependent cardiac surgery to evaluate whether pulmonary perfusion
with oxygenated blood or custodiol HTK solution reduces postoperative
pulmonary dysfunction in COPD patients. Further, we aim for a
non-randomized evaluation of postoperative pulmonary function after
transcatheter aortic-valve implantation (TAVI). The primary outcome
measure is the oxygenation index measured from anesthesia induction to
the end of surgery and until 24 hours after anesthesia induction for a
total of six evaluations.

DISCUSSION:

Patients with COPD
may be impaired by hypoxemia and SIRS. Thus, prolonged recovery and even
postoperative complications and death may be reflected by the degree of
hypoxemia and SIRS. The limited sample size does not aim for
confirmatory conclusions on mortality, cardiovascular complications or
risk of pneumonia and sepsis, but the PP-Trial is considered an
important feasibility trial paving the road for a multicenter
confirmatory trial.