Effects of Prostacyclin During Cardiopulmonary Bypass in Man

Abstract

Effects of prostacyclin infusion were studied in adult patients operated on for acquired heart disease during the period November 1979-June 1980. In group A. 10 patients received prostacyclin 50 ng × kg b.w.⁻¹ x min⁻¹ for the first 30 min of cardiopulmonary bypass (CPB). Twelve patients served as controls. In group B, 14 patients received prostacyclin 100 ng × kg b.w.⁻¹ x min⁻¹ throughout CPB apart from the last 5-20 min. Nine patients served as controls. CPB was by roller pump and bubble oxygenator primed with a crystalloid solution. Hypothermia to 25-28^°C was induced. All patients were given heparin 3 mg/kg b.w. before cannulation + 50-75 mg added to the pump prime.

There were 3 deaths in the control groups and 1 death in the prostacyclin groups. One control and 2 prostacyclin patients were re-operated on for bleeding. There was no difference between control and prostacyclin patients in regard to intra- or postoperative bleeding. One prostacyclin patient operated on for calcific aortic stenosis suffered hemiplegia. There were no other instances of cerebral damage in prostacyclin patients, whereas 2 control patients with prolonged CPB showed severe damage. Infusion of prostacyclin reduced aortic blood pressure (often to less than 30 mmHg) and systemic vascular resistance was decreased by approximately 50% during infusion.

The platelet count corrected for haematocrit was significantly (p < 0.01) better preserved in prostacyclin patients than in control patients both during and after CPB. After 90 min of CPB, the platelet count in control patients was (X ± S.D.) 71±19% and in prostacyclin patients 100±22% of pre-CPB value. Platelet aggregation induced by ADP and collagen was abolished in group B patients during prostacyclin infusion and they showed a tendency to better ADP induced platelet aggregation after bypass in comparison with control patients.