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J Thorac Cardiovasc Surg 1999;118:107-114
© 1999 Mosby, Inc.

CARDIOTHORACIC TRANSPLANTATION

PREIMPLANTATION RETROGRADE PNEUMOPLEGIA IN CLINICAL LUNG TRANSPLANTATION

From the University of Rome "La Sapienza," Departments of Thoracic Surgery^a and Anesthesia,^b Rome, Italy.

Read at the Twenty-fourth Annual Meeting of The Western Thoracic Surgical Association, Whistler, British Columbia, June 24-27, 1998.

Address for reprints: Federico Venuta, MD, Cattedra di Chirurgia Toracica, Policlinico Umberto I, University of Rome "La Sapienza," V. le del Policlinico, 00100 Rome, Italy (E-mail: Fevenuta{at}tin.it).

Objective: Retrograde pneumoplegia seems to improve early graft function in experimental and clinical lung transplantation. We evaluated the role of retrograde flushing in addition to antegrade pneumoplegia in clinical lung transplantation.
Methods: Fourteen patients undergoing lung transplantation were randomized into 2 groups: in group I we performed antegrade pulmonary artery flushing with alprostadil (prostaglandin E₁) and modified Euro-Collins solution at the time of retrieval. In group II additional retrograde flushing through the pulmonary veins was performed at the back table, before reimplantation. Hemodynamic variables, mean airway pressure, and blood gas analysis were monitored at different time points. Postoperative volumetric monitoring was performed to assess extravascular lung water. The reimplantation response was assessed by a radiographic score; extubation time and intensive care unit stay were recorded.
Results: During retrograde flushing, blood and clots coming out from the pulmonary artery were observed; 2 lungs harvested from a donor with multiple bone fractures had fat emboli in the retrograde perfusate. Hemodynamic monitoring did not demonstrate any difference between the 2 groups. The ratio of arterial oxygen tension to inspired oxygen fraction, extravascular lung water, duration of intubation, and length of stay in the intensive care unit were improved in group II, but the differences did not reach statistical significance. Intrapulmonary shunt fraction was significantly improved in group II at each time point ( P = .02), as well as indexed alveolar-arterial oxygen tension gradient (P = .04), mean airway pressure (P = .04), and chest x-ray score ( P = .03).
Conclusions: Preimplantation retrograde flushing is not detrimental and helps to improve early graft function.

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