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J Thorac Cardiovasc Surg 2000;119:635-636
© 2000 Mosby, Inc.

LETTERS TO THE EDITOR

Preimplantation retrograde pneumoplegia in clinical lung transplantation

Cardiac Surgery, The Royal Victoria Hospital, Grosvenor Rd, Belfast BT12 6BA, Northern Ireland

To the Editor:

I read with interest the article by Venuta and associates ¹ concerning 14 consecutive patients who underwent lung transplantation. The first patients, group I, had antegrade pneumoplegia with Euro-Collins solution preceded by pulmonary arterial flushing with alprostadil (prostaglandin E₁). In group II, additional retrograde flushing was given via the pulmonary veins just before implantation. The authors concluded that retrograde flushing is not detrimental and helps to improve early graft function. The chest x-ray score was significantly better in group II, intubation time was less, and the ratio of arterial PO₂ to inspired oxygen fraction was improved, although the differences did not reach statistical significance.

My colleagues and I ² were the first group to use retrograde pneumoplegia in clinical transplantation. However, we did not use antegrade pneumoplegia in those patients, nor did we use alprostadil. The retrograde pneumoplegic solution was given via the left atrium and the flush solution was vented through an incision in the pulmonary artery. This was done immediately after the aorta was crossclamped and cardioplegia established. The lung almost seemed to light up as the retrograde infusion started. Retrograde pneumoplegia was associated with excellent oxygenation, which remains the most sensitive indicator of the adequacy of lung preservation, as well as the lack of any reimplantation response postoperatively, a finding also shown by the current study. What Venuta’s study really demonstrates is that retrograde pneumoplegia may confer additional benefits to lung preservation compared with those of antegrade pneumoplegia alone.

Two criticisms can be leveled at this study. First, retrograde pneumoplegia was given after harvesting of the donor lung, not at the time of the harvesting. This point has already been addressed, and the current practice of the group is to give the retrograde perfusion solution immediately after the antegrade perfusion is finished. The second criticism is that pneumoplegic solution was given individually into each pulmonary vein. This method is at variance with our technique, in which the pneumoplegic solution was given into the left atrium and therefore had a uniform distribution through both lungs, something that cannot be guaranteed if individual veins are perfused separately.

I do congratulate Venuta and his colleagues for highlighting the potential advantage of retrograde pulmonary perfusion in clinical lung transplantation.

doi:10.1067/mtc.2000.105055

References

1. Venuta F, Rendina EA, Bufi M, Della Rocca G, De Giacomo T, Costa MG, et al. Preimplantation retrograde pneumoplegia in clinical lung transplantation. J Thorac Cardiovasc Surg 1999;118:107-14.[Abstract/Free Full Text]
   
2. Sarsam MAI, Yonan NA, Deiraniya AK, Rahman AN. Retrograde pulmonaryplegia for lung preservation in clinical transplantation: a new technique. J Heart Lung Transplant 1993;12:494-8.[Medline]
   

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