| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 1998;115:415-425
© 1998 Mosby, Inc.
CARDIAC AND PULMONARY REPLACEMENT |
Sponsor:
*Supported in part by the Pillsbury Fellowship.
Read at the Seventy-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, D.C., May 4-7, 1997.
Received for publication May 7, 1997; revisions requested Aug. 12, 1997; revisions received Sept. 12, 1997; accepted for publication Sept. 15, 1997. Address for reprints: Bradley S. Allen, MD, Cardiothoracic Surgery Division, Suite 417 CSB (M/C 958), University of Illinois at Chicago, 840 South Wood St., Chicago, IL 60612.
Abstract
Objectives: Despite improvements in organ preservation, reperfusion injury remains a major source of morbidity and mortality after lung transplantation. This pilot study was designed to investigate the effects of controlled reperfusion after lung ischemia.
Methods: Twenty adult pigs underwent 2 hours of warm lung ischemia by crossclamping the left bronchus and pulmonary artery. In five (group 1), the clamp was simply removed at the end of ischemia (uncontrolled reperfusion). The 15 other pigs underwent modified reperfusion using blood from the femoral artery to perfuse the lung through the pulmonary artery (pressure 40 to 50 mm Hg) for 10 minutes before removing the pulmonary artery clamp. In five (group 2), the blood was mixed with crystalloid, resulting in a substrate-enriched, hypocalcemic, hyperosmolar, alkaline solution. In five (group 3), the blood was circulated through a leukocyte-depleting filter, and the last five (group 4) underwent reperfusion with both a modified solution and white blood cell filter. Lung function was assessed 60 minutes after reperfusion, and biopsy specimens were taken.
Results: Controlled reperfusion with both a white blood cell filter and modified solution (group 4) completely eliminated the reperfusion injury that occurred with uncontrolled reperfusion (group 1), resulting in complete preservation of compliance (98% ± 1% vs 77% ± 1%; p < 0.001, and arterial/alveolar ratio (97% ± 2% vs 27% ± 2%; p < 0.001); no increase in pulmonary vascular resistance (106% ± 1% vs 198% ± 1%; p < 0.001); lowered tissue edema (82.1% ± 0.4% vs 84.3% ± 0.2%; p < 0.001), and myeloperoxidase activity (0.18 ± 0.02 vs 0.35 ± 0.02 
OD/min/mg protein; p < 0.001). In contrast, using either a white blood cell filter or modified solution separately improved but did not avoid the reperfusion injury, resulting in pulmonary function and tissue edema levels that were intermediate between group 1 (uncontrolled reperfusion) and group 4 (white blood cell filter and modified solution).
Conclusion: After 2 hours of warm pulmonary ischemia, (1) a severe lung injury occurs after uncontrolled reperfusion, (2) controlled reperfusion with either a modified reperfusion solution or white blood cell filter limits, but does not avoid, a lung reperfusion injury, (3) reperfusion using both a modified reperfusate and white blood cell filter results in complete preservation of pulmonary function. We therefore believe surgeons should control the reperfusate after lung transplantation to improve postoperative pulmonary function. (J Thorac Cardiovasc Surg 1998;115:415-25)
This article has been cited by other articles:
|
|
 |
|
  H. Kagawa, K. Morita, R. Nagahori, G. Shinohara, K. Kinouchi, and K. Hashimoto Prevention of ischemia/reperfusion-induced pulmonary dysfunction after cardiopulmonary bypass with terminal leukocyte-depleted lung reperfusion J. Thorac. Cardiovasc. Surg., January 1, 2010; 139(1): 174 - 180. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Lang, C. Aigner, G. Winkler, K. Shkirdladze, W. Wisser, G. Dekan, M. Tamura, G. Heinze, D. Van Raemdonck, and W. Klepetko Prolonged venoarterial extracorporeal membrane oxygenation after transplantation restores functional integrity of severely injured lung allografts and prevents the development of pulmonary graft failure in a pig model. J. Thorac. Cardiovasc. Surg., June 1, 2009; 137(6): 1493 - 1498. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Ailawadi, C. L. Lau, P. W. Smith, B. R. Swenson, S. A. Hennessy, C. J. Kuhn, L. M. Fedoruk, B. D. Kozower, I. L. Kron, and D. R. Jones Does reperfusion injury still cause significant mortality after lung transplantation? J. Thorac. Cardiovasc. Surg., March 1, 2009; 137(3): 688 - 694. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. M. Egan, J. A. Haithcock, W. A. Nicotra, G. Koukoulis, H. Inokawa, M. Sevala, P. L. Molina, W. K. Funkhouser, and B. J. Mattice Ex Vivo Evaluation of Human Lungs for Transplant Suitability Ann. Thorac. Surg., April 1, 2006; 81(4): 1205 - 1213. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. T. Schnickel, D. J. Ross, R. Beygui, A. Shefizadeh, H. Laks, R. Saggar, J. P. Lynch III, and A. Ardehali Modified reperfusion in clinical lung transplantation: The results of 100 consecutive cases J. Thorac. Cardiovasc. Surg., January 1, 2006; 131(1): 218 - 223. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. L. Lau, G. A. Patterson, and S. M. Palmer Critical Care Aspects of Lung Transplantation J Intensive Care Med, March 1, 2004; 19(2): 83 - 104. [Abstract] [PDF]
|
|
|
|
|
|
B. S. Allen, M. Castella, G. D. Buckberg, and Z. Tan Conditioned blood reperfusion markedly enhances neurologic recovery after prolonged cerebral ischemia J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 1851 - 1858. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Ardehali, H. Laks, H. Russell, M. Levine, R. Shpiner, S. Lackey, and D. Ross Modified reperfusion and ischemia-reperfusion injury in human lung transplantation J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 1929 - 1934. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.L. Lau and G.A. Patterson Current status of lung transplantation Eur. Respir. J., November 16, 2003; 22(47_suppl): 57s - 64s. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. S. Allen, J. S. Veluz, G. D. Buckberg, E. Aeberhard, and L. J. Ignarro Deep hypothermic circulatory arrest and global reperfusion injury: Avoidance by making a pump prime reperfusate--A new concept J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(3): 625 - 632. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. de Perrot, M. Liu, T. K. Waddell, and S. Keshavjee Ischemia-Reperfusion-induced Lung Injury Am. J. Respir. Crit. Care Med., February 15, 2003; 167(4): 490 - 511. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Y. Szeto, D. Kreisel, G. C. Karakousis, A. Pochettino, D. H. Sterman, R. M. Kotloff, S. M. Arcasoy, D. A. Zisman, N. P. Blumenthal, R. J. Gallop, et al. Cardiopulmonary bypass for bilateral sequential lung transplantation in patients with chronic obstructive pulmonary disease without adverse effect on lung function or clinical outcome J. Thorac. Cardiovasc. Surg., August 1, 2002; 124(2): 241 - 249. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Pereszlenyi, G. Lang, H. Steltzer, H. Hetz, A. Kocher, P. Neuhauser, W. Wisser, and W. Klepetko Bilateral lung transplantation with intra- and postoperatively prolonged ECMO support in patients with pulmonary hypertension Eur. J. Cardiothorac. Surg., May 1, 2002; 21(5): 858 - 863. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. S Allen The role of leukodepletion in limiting ischemia/reperfusion damage in the heart, lung and lower extremity Perfusion, March 1, 2002; 17(2_suppl): 11 - 22. [Abstract] [PDF]
|
|
|
|
|
|
M. Kurusz, J. D Roach Jr, R. A Vertrees, M. K Girouard, and S. D Lick Leukocyte filtration in lung transplantation Perfusion, March 1, 2002; 17(2_suppl): 63 - 67. [Abstract] [PDF]
|
|
|
|
|
|
R. Faro, Y. Toyoda, J. D. McCully, P. Jagtap, E. Szabo, L. Virag, C. Bianchi, S. Levitsky, C. Szabo, and F. W. Sellke Myocardial protection by PJ34, a novel potent poly (ADP-ribose) synthetase inhibitor Ann. Thorac. Surg., February 1, 2002; 73(2): 575 - 581. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S J Morris Leukocyte reduction in cardiovascular surgery Perfusion, September 1, 2001; 16(5): 371 - 380. [PDF]
|
|
|
|
|
|
B. S. Allen Controlled pulmonary reperfusion: what is the optimal method of delivery? Ann. Thorac. Surg., October 1, 2000; 70(4): 1449 - 1450. [Full Text] [PDF]
|
|
|
|
|
|
S. D. Lick, P. S. Brown Jr, M. Kurusz, R. A. Vertrees, C. K. McQuitty, and W. E. Johnston Technique of controlled reperfusion of the transplanted lung in humans Ann. Thorac. Surg., March 1, 2000; 69(3): 910 - 912. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Halldorsson Ann. Thorac. Surg., March 1, 2000; 69(3): 912 - 912. [Full Text] [PDF]
|
|
|
|
|
|
A. O. Halldorsson, M. T. Kronon, B. S. Allen, S. Rahman, and T. Wang Lowering reperfusion pressure reduces the injury after pulmonary ischemia Ann. Thorac. Surg., January 1, 2000; 69(1): 198 - 203. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. Kronon, B. S. Allen, A. Halldorsson, S. Rahman, T. Wang, and M. Ilbawi DOSE DEPENDENCY OF L-ARGININE IN NEONATAL MYOCARDIAL PROTECTION: THE NITRIC OXIDE PARADOX J. Thorac. Cardiovasc. Surg., October 1, 1999; 118(4): 655 - 664. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. Kronon, B. S. Allen, A. Halldorsson, S. Rahman, T. Wang, and M. Ilbawi L-ARGININE, PROSTAGLANDIN, AND WHITE CELL FILTRATION EQUALLY IMPROVE MYOCARDIAL PROTECTION IN STRESSED NEONATAL HEARTS J. Thorac. Cardiovasc. Surg., October 1, 1999; 118(4): 665 - 673. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. O. Halldorsson, M. Kronon, B. S. Allen, S. Rahman, T. Wang, M. Layland, and D. Sidle Controlled reperfusion prevents pulmonary injury after 24 hours of lung preservation Ann. Thorac. Surg., September 1, 1998; 66(3): 877 - 885. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
