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J Thorac Cardiovasc Surg 2005;130:1342-1347
© 2005 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Circulating big endothelin-1: An active role in pulmonary thromboendarterectomy?

Frank Langer, MD a , Michael Bauer, MD b , Dietmar Tscholl, MD a , Rene Schramm, MD a , Takashi Kunihara, MD a , Henning Lausberg, MD a , Thomas Georg, MD c , Heinrike Wilkens, MD d , Hans-Joachim Schäfers, MD a , *

a Department of Thoracic and Cardiovascular Surgery, University Hospital Homburg, Homburg, Germany
b Department of Anesthesiology and Critical Care, Friedrich-Schiller-University, Jena, Germany
c Department of Epidemiology and Biostatistics, University Hospital Homburg, Homburg, Germany
d Department of Pulmonary Medicine, University Hospital Homburg, Homburg, Germany

Received for publication February 18, 2005; revisions received April 15, 2005; accepted for publication June 8, 2005.

* Address for reprints: Hans-Joachim Schäfers, MD, Department of Thoracic and Cardiovascular Surgery, University Hospital Homburg, University of Saarland, Kirrberger Str, D-66421 Homburg/Saar, Germany (Email: chhjsc{at}uniklinik-saarland.de).

BACKGROUND: Pulmonary thromboendarterectomy is an effective treatment for patients with chronic thromboembolic pulmonary hypertension. The early postoperative course may be associated with pulmonary vasoconstriction and profound systemic vasodilation. We investigated the potential involvement of endothelins in these hemodynamic alterations.

METHODS: Seventeen patients with chronic thromboembolic pulmonary hypertension (pulmonary vascular resistance, 1015 ± 402 dyne·s·cm–5 [mean ± SD]) underwent pulmonary thromboendarterectomy with cardiopulmonary bypass and deep hypothermic circulatory arrest. Peripheral arterial blood samples were drawn before sternotomy, during cardiopulmonary bypass before and after deep hypothermic circulatory arrest, and 0, 8, 16, and 24 hours after surgery and were analyzed for big endothelin-1. The patients were divided into 2 groups according to whether their preoperative big endothelin-1 plasma level was above or below the cutoff point of 2.1 pg/mL, as determined by receiver operating characteristic curve analysis (group A, big endothelin-1 <2.1 pg/mL, n = 8; group B, big endothelin-1 ≥2.1 pg/mL, n = 9).

RESULTS: Patients in group B, with higher preoperative big endothelin-1 levels (3.2 ± 1.0 pg/mL vs 1.5 ± 0.4 pg/mL; P < .001), were poorer operative candidates (preoperative mean pulmonary artery pressure, 51.3 ± 7.1 mm Hg vs 43.6 ± 6.2 mm Hg; P = .006) and had a poorer outcome (mean pulmonary artery pressure 24 hours after surgery, 32.6 ± 9.5 mm Hg vs 21.8 ± 6.2 mm Hg; P < .001). Positive correlations were found between preoperative big endothelin-1 levels and preoperative mean pulmonary artery pressure (r = 0.56; P = .02) as well as postoperative mean pulmonary artery pressure at 0 hours (r = 0.70; P = .002) and 24 hours (r = 0.63; P = .006) after surgery. Preoperative big endothelin-1 levels predicted outcome (postoperative mean pulmonary artery pressure at 24 hours after surgery) after pulmonary thromboendarterectomy (area under the receiver operating characteristic curve, 0.85). Peak big endothelin-1 levels also correlated with maximal vasopressor dosage (r = 0.65; P = .004).

CONCLUSIONS: Preoperative big endothelin-1 levels seem to correlate with the hemodynamic alterations observed in pulmonary thromboendarterectomy and may be used to predict hemodynamic outcome after pulmonary thromboendarterectomy.

Abbreviations and Acronyms AUC = area under the curve; CPB = cardiopulmonary bypass; CTEPH = chronic thromboembolic pulmonary hypertension; DHCA = deep hypothermic circulatory arrest; ET = endothelin; MPAP = mean pulmonary artery pressure; PTE = pulmonary thromboendarterectomy; PVR = pulmonary vascular resistance; ROC = receiver operating characteristic






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