2006 - UZ Leuven

ight heart failure manifested by acute dilation of the right ventriclefollowing ligation of the hilum of the right lung.Conclusion: Single lung transplantation with exclusion of thecontralateral native lung is a critical model. Arterial end-to-endanastomosis resulted in an increased right ventricular afterload. Theuse of a patch technique improved the compliance of the arterialanastomosis and decreased early mortality. This transplant model iscurrently used in our laboratory to assess new methods for pulmonarypreservation.VAN DE WAUWER A., NEYRINCK A., GEUDENS N., REGA F.,VERLEDEN G.M., LERUT T., VAN RAEMDONCK D.E.M.: Retrogradeflush after topical cooling in the non-heart-beating donor results inimproved pulmonary graft function. Interactive Cardiovasc. Thor. Surg.,2006; 5(2): S218 (134-0).Objectives: The use of non-heart beating donors (HNBD) has beenpropagated as an alternative to overcome the scarcity of pulmonarygrafts. However, formation of microthrombi after circulatory arrest isstill a concern for the development of reperfusion injury. We looked atthe effect and the best route of pulmonary flush after topical cooling.Methods: Non-heparinised pigs were sacrificed by ventricularfibrillation and divided in 3 groups (n=6/group). After 1 h of in situwarm ischaemia and 2.5 h of topical cooling, lungs in group I wereretrieved unflushed (NF). In group II, lungs were explanted followingan antegrade flush (AF) through the pulmonary artery with 50 ml/kgPerfadex ® . Finally, in group III, lungs were explanted after an identicalbut retrograde flush (RF) via the left atrium. Flush effluent wassampled at intervals to measure haemoglobin concentration.Performance of the left lung was assessed during 60 min in our exvivoreperfusion model.Results: Haemoglobin concentration (g/dl) was initially higher after RFvs. AF (3,4 ± 1.1 vs. 0.6 ± 0.1) (P < 0.05). Pulmonary vascularresistance (dynes*sec*cm -5 ) was 975 ± 85 (RF) vs. 1567 ± 98 (AF)and 1576 ± 88 (NF) at 60 min of reperfusion (P < 0.001). Oxygenation(mmHg) and compliance (ml/cmH 2 O) were higher and plateau airwaypressure (cmH 2 O) was lower after FR vs. AF and NF (491 ± 44 vs.472 ± 61 and 430 ± 33 (NS); 22 ± 3 vs. 19 ± 3 and 14 ± 1 (NS); 11 ± 1vs. 13 ± 1 and 13 ± 1 (NS), respectively. No differences in W/D wereobserved after reperfusion.Conclusions: Retrograde flush in the non-heart-beating donor resultsin a more effective flush-out and subsequent reduced pulmonaryvascular resistance upon reperfusion.114