Importance of left atrial pressure during ex vivo lung perfusion

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• 作者：Virginia Linacre ; MD ; Marcelo Cypel ; MD ; MSc ; ^{marcelo.cypel@uhn.ca" class="auth_mail" title="E-mail the corresponding author} ; Tiago Machuca ; MD ; Daisuke Nakajima ; MD ; Kohei Hashimoto ; MD ; Ricardo Zamel ; PhD ; Manyin Chen ; MD ; Ilker Iskender ; MD ; Pedro dos Santos ; MD ; Thomas K. Waddell ; MD ; Mingyao Liu ; MD ; Shaf Keshavjee ; MD
• 关键词：lung transplantation ; ex vivo lung perfusion ; left atrium pressure ; pulmonary edema ; donor lungs
• 刊名：Journal of Heart and Lung Transplantation
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：35
• 期：6
• 页码：808-814
• 全文大小：1525 K

文摘

Ex vivo lung perfusion (EVLP) allows for the evaluation and treatment of donor lungs before transplant. Different EVLP strategies have been described using either an open left atrium (LA) (pressure of 0 mm Hg) or closed LA (pressure of 5 mm Hg). We hypothesized that maintaining a physiologic positive LA pressure during EVLP is protective to the lung.

Methods

Pig lungs were flushed with Perfadex, retrieved and stored at 4°C for 4 hours [short cold ischemic time (CIT), m>nm> = 10] or 18 hours (prolonged CIT, m>nm> = 8). Subsequently, lungs underwent normothermic EVLP for 12 hours using either an open or closed LA technique. A linear mixed effect model was used to compare functional parameters between the 2 groups.

Results

After short CIT, 12-hour EVLP could not be completed in 4 of 5 open atrium cases due to significant pulmonary edema. Lung injury was evident in this group after 7 hours of EVLP, demonstrating an increase in pulmonary vascular resistance (m>pm> < 0.001) and peak inspiratory pressure (m>pm> = 0.001), and a decrease in lung compliance (m>pm> < 0.001) and perfusate oxygenation (m>pm> = 0.04). In contrast, in the closed atrium group, all lungs completed 12 hours of EVLP with stable functional parameters. At the end of the experiment, the wet/dry ratio (m>pm> = 0.015) and lung edema score (m>pm> = 0.02) were significantly worse in the open LA group compared with the closed LA EVLP group. Similar findings were observed in the prolonged CIT group.

Conclusion

The use of a closed atrial technique to create a controlled positive LA during EVLP leads to significantly less edema and superior lung physiology.