Role of hemolysis on pulmonary arterial compliance and right ventricular systolic function after cardiopulmonary bypass

• Published in: Nitric oxide Vol. 146; pp. 24 - 30
• Main Authors: Rezoagli, Emanuele, Redaelli, Simone, Bittner, Edward A., Fumagalli, Roberto, Ichinose, Fumito, Berra, Lorenzo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2024
• Subjects: Cardiopulmonary bypass; Haptoglobin; Hemolysis; Iron metabolism; Nitric oxide; Pulmonary arterial compliance; Pulmonary vascular resistance; Right ventricular function; Hemolysis; Pulmonary arterial compliance; Cardiopulmonary bypass; Iron metabolism; Haptoglobin; Right ventricular function; Nitric oxide; Pulmonary vascular resistance
• ISSN: 1089-8603; 1089-8611; 1089-8611
• DOI: 10.1016/j.niox.2024.03.003

Cardiopulmonary bypass (CPB) is associated with intravascular hemolysis which depletes endogenous nitric oxide (NO). The impact of hemolysis on pulmonary arterial compliance (PAC) and right ventricular systolic function has not been explored yet. We hypothesized that decreased NO availability is associated with worse PAC and right ventricular systolic function after CPB. This is a secondary analysis of an observational cohort study in patients undergoing cardiac surgery with CPB at Massachusetts General Hospital, USA (2014–2015). We assessed PAC (stroke volume/pulmonary artery pulse pressure ratio), and right ventricular function index (RVFI) (systolic pulmonary arterial pressure/cardiac output), as well as NO consumption at 15 min, 4 h and 12 h after CPB. Patients were stratified by CPB duration. Further, we assessed the association between changes in NO consumption with PAC and RVFI between 15min and 4 h after CPB. PAC was lowest at 15min after CPB and improved over time (n = 50). RVFI was highest -worse right ventricular function- at CPB end and gradually decreased. Changes in hemolysis, PAC and RVFI differed over time by CPB duration. PAC inversely correlated with total pulmonary resistance (TPR). TPR and PAC positively and negatively correlated with RVFI, respectively. NO consumption between 15min and 4 h after CPB correlated with changes in PAC (−0.28 ml/mmHg, 95%CI −0.49 to −0.01, p = 0.012) and RVFI (0.14 mmHg*L−1*min, 95%CI 0.10 to 0.18, p < 0.001) after multivariable adjustments. PAC and RVFI are worse at CPB end and improve over time. Depletion of endogenous NO may contribute to explain changes in PAC and RVFI after CPB. •Pulmonary arterial compliance (PAC) gradually increases after cardiopulmonary bypass (CPB).•PAC inversely correlates with total pulmonary resistance (TPR) after CPB.•TPR and PAC positively and negatively correlate with right ventricle function after CPB, respectively.•NO consumption, which reflects changes in hemolysis, independently correlates with PAC and right ventricle function after CPB.•Hemolysis may contribute to changes in PAC and right ventricle function after CPB.