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J Thorac Cardiovasc Surg 1998;115:990-994
© 1998 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

Cardiopulmonary bypass is associated with early allograft dysfunction but not death after double-lung transplantation

From the Division of Cardiothoracic Surgery, The University of Pittsburgh Medical Center, Pittsburgh, Pa.

Read at the Twenty-second Annual Meeting of The Western Thoracic Surgical Association, Maui, Hawaii, June 26-29, 1996.

Received for publication March 10, 1997. Revisions requested May 21, 1997; revisions received Dec. 11, 1997. Accepted for publication Dec. 11, 1997. Address for reprints: James S. Gammie, MD, University of Pittsburgh, Division of Cardiothoracic Surgery, C-700 Scaife, 200 Lothrop St., Pittsburgh, PA 15213.

Abstract

Objectives: To assess the effect of cardiopulmonary bypass on allograft function and recipient survival in double-lung transplantation.
Methods: Retrospective review of 94 double-lung transplantations.
Results: Cardiopulmonary bypass was used in 37 patients (CPB); 57 transplantations were accomplished without bypass (no-CPB). Bypass was routinely used for patients with pulmonary hypertension (n = 27) and for two recipients undergoing en bloc transplantation. Cardiopulmonary bypass was required in eight (12.3%) of the remaining 65 patients. Mean ischemic time was longer in the CPB group (346 vs 315 minutes, p = 0.04). The CPB group required more perioperative blood (11.4 vs 6.0 units, p = 0.01). Allograft function, assessed by the arterial/alveolar oxygen tension ratio, was better in the no-CPB group at 12 and 24 hours after operation (0.54 vs 0.39 at 12 hours, p = 0.002; and 0.63 vs 0.38 at 24 hours, p = 0.001). The CPB group had more severe pulmonary infiltrates at both 1 and 24 hours (p = 0.005). Diffuse alveolar damage was more common in the CPB group (69% vs 35%, p = 0.002). Median duration of intubation was longer in the CPB group (10 days) than in the no-CPB group (2 days, p = 0.002). The 30-day mortality rate (13.5% vs 7.0% in the CPB and no-CPB groups) and 1-year survival (65% vs 67%, CPB and no-CPB) were not significantly different.
Conclusions: In the absence of pulmonary hypertension, cardiopulmonary bypass is only occasionally necessary in double-lung transplantation. Bypass is associated with substantial early allograft dysfunction after transplantation.

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