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J Thorac Cardiovasc Surg 2002;124:241-249
© 2002 The American Association for Thoracic Surgery

Cardiothoracic Transplantation (TX)

Cardiopulmonary bypass for bilateral sequential lung transplantation in patients with chronic obstructive pulmonary disease without adverse effect on lung function or clinical outcome

From the Department of Surgery, Division of Cardiothoracic Surgery,^a and the Department of Medicine, Division of Pulmonary Medicine and Critical Care,^b Hospital of the University of Pennsylvania, Philadelphia, Pa, and the Department of Mathematics and Applied Statistics,^c West Chester University, West Chester, Pa.

Received for publication May 9, 2001. Revisions requested June 15, 2001; revisions received Oct 10, 2001. Accepted for publication Oct 24, 2001. Address for reprints: Bruce R. Rosengard, MD, Division of Cardiothoracic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St, Silverstein 6th Floor, Philadelphia, PA 19104 (E-mail: brosenga{at}mail.med.upenn.edu).

Objective: The use of cardiopulmonary bypass in lung transplantation remains controversial. Previous studies have concluded that cardiopulmonary bypass is deleterious, but these studies were confounded by the inclusion of patients with different diagnoses undergoing single- and double-lung transplantation with elective or emergency use of bypass. The goal of this study was to determine whether cardiopulmonary bypass has deleterious effects on lung function or clinical outcome by analyzing the cases of patients with a single disease entity and elective use of bypass for bilateral sequential lung transplantation.
Methods: A retrospective review of 50 patients with chronic obstructive pulmonary disease who underwent bilateral sequential lung transplantation was performed. Fourteen patients who underwent elective cardiopulmonary bypass for 218.3 ± 75.4 minutes were compared to 36 control patients.
Results: After the operation, the bypass and nonbypass groups were not significantly different with respect to median duration of mechanical ventilation (1 day vs 1 day, P = .76), median stay in the intensive care unit (4 days vs 4 days, P = .44), median hospital stay (15.5 days vs 16 days, P = .74), mean increase in serum creatinine level (1.4 ± 1.9 mg/dL vs 0.9 ± 1.0 mg/dL, P = .33), and mean ratio of PaO₂ to fraction of inspired oxygen at 1 hour (376.6 ± 123 vs 357.0 ± 218, P = .75), at 24 hours (309.9 ± 92 vs 350.6 ± 122, P = .26), and at 48 hours (335.0 ± 144 vs 316.2 ± 120, P = .64). Late outcome markers compared between the bypass and nonbypass groups were the following: 1-year percentage predicted forced expiratory volume in 1 second (76.1% ± 17.0% vs 85.3% ± 21.7%, P = .24), 30-day mortality (7.1% vs 8.3%, P > .999), 1-year survival (85.7% vs 80.1%, P = .66), 3-year survival (64.3% vs 58.3%, P = .70), and the prevalence of bronchiolitis obliterans syndrome (0% vs 36.1%, P = .01).
Conclusion: Cardiopulmonary bypass appears to have no deleterious effect on early lung function or clinical outcome. We hope that this pilot study removes some of the unwarranted fear of the use of bypass in lung transplantation for chronic obstructive pulmonary disease.

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