Cardiopulmonary bypass during a second-lung implantation improves postoperative oxygenation after sequential double-lung transplantation.

Abstract

OBJECTIVES:

During sequential double-lung transplantation (DLT), the newly implanted first lung receives the entire cardiac output during the implantation of the second one. This may be responsible for the increased hydrostatic pressure that causes severe interstitial and alveolar edema that can lead to allograft dysfunction. The authors tested the hypothesis that CPB started after first graft implantation and before second recipient lung removal should improve post-transplantation oxygenation and clinical outcomes.

DESIGN:

Observational during 2 consecutive 1-year periods.

SETTING:

University hospital.

PARTICIPANTS:

Nine consecutive patients undergoing sequential DLT with CPB started after first graft implantation and before second recipient lung removal were compared to controls, who were 10 consecutive patients who underwent sequential DLT but without CPB the year before.

MEASUREMENTS AND MAIN RESULTS:

Oxygenation after transplantation was assessed. The use of CPB during the implantation of the second lung was associated with an increased mean postoperative ratio of PaO2 to the fraction of inspired oxygen at 1 hour (363±51 v 240±113, p = 0.01) and 6 hours (430±111 v 280±103, p = 0.03). The mean duration of CPB was 111±19 min. The occurrence of primary graft dysfunction and the need for extracorporeal membrane oxygenation tended to be lower, but did not reach significance. Similarly, mortality rate was comparable between both groups, as was the rate of blood transfusions.

CONCLUSIONS:

The authors' results suggest that the use of CPB started after first graft implantation and before second recipient lung removal appears to benefit oxygenation and reduces the occurrence of severe pulmonary edema in the first transplanted lung.

• Authors: Hadrien Rozé, Matthieu Thumerel, Laurent Barandon, Claire Dromer, Virginie Perrier, Jacques Jougon, Jean-François Velly, Alexandre Ouattara
• Journal: Journal of cardiothoracic and vascular anesthesia (J Cardiothorac Vasc Anesth) Vol. 27 Issue 3 Pg. 467-73 (Jun 2013) ISSN: 1532-8422 [Electronic] United States
• PMID: 23541362 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Topics

• Aged
• Cardiopulmonary Bypass (adverse effects, methods)
• Echocardiography, Transesophageal
• Female
• Humans
• Lung Diseases (surgery)
• Lung Transplantation (adverse effects, physiology)
• Male
• Middle Aged
• Oxygen Consumption (physiology)
• Postoperative Care
• Postoperative Complications (epidemiology, therapy)
• Postoperative Period
• Pulmonary Circulation (physiology)
• Reperfusion Injury (etiology, therapy)
• Treatment Outcome