OBJECTIVE: Although surgeons use gas insufflation to maintain a bloodless field in the coronary bypass operations with coronary arteries blood-perfused, gas insufflation potentially causes coronary endothelial damage. The present study was designed to determine the adverse effects of gas insufflation on the coronary endothelium and the protective efficacy of humidified gas with heparinized solution in the beating dog hearts. METHODS: After systemic heparinization, a 5-mm longitudinal coronary arteriotomy was made through left thoracotomy. The arteriotomy was exposed to nonhumidified carbon dioxide (n=6), humidified carbon dioxide with lactated Ringer solution (n=6), or humidified carbon dioxide with heparinized lactated Ringer solution (n=6) for 20 min. After gas insufflation, the arteriotomy was repaired, then the coronary was reperfused. The coronary was rinsed, then perfusion-fixation was done. The coronary endothelium was observed by scanning electron microscopy, the adverse effect on the endothelium was graded as follows; grade 1 = appeared normal, grade 2 = few blood cells deposited, grade 3 = many blood cells deposited, grade 4 = few endothelial cells delaminated with blood cells deposited, grade 5 = many endothelial cells delaminated with many blood cells deposited. RESULTS: Nonhumidified gas blowing caused endothelial cell damage (mean grade = 3.67). In contrast, blood cells were deposited on the endothelium without endothelial delaminations (mean grade = 1.67) by 20-min humidified gas blowing. In case of heparin-added humidification, less blood cells were deposited on the intact endothelium (mean grade = 1.17). CONCLUSION: Nonhumidified gas insufflation made blood cells deposited and endothelial cells delaminated. Humidified gas insufflation attenuated these adverse effects especially in case of heparin-added humidification.
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Okazaki et al. (2000) studied this question.