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Ann Thorac Surg 1984;37:479-483
© 1984 The Society of Thoracic Surgeons

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Articles

Acute Physiological Changes Following Heart-Lung Allotransplantation in Dogs

From the Departments of Cardiovascular Surgery and Anesthesia, Stanford University School of Medicine, Stanford, CA

Accepted for publication November 28, 1983.

^* Address reprint requests to Dr. Baumgartner, Johns Hopkins University Hospital, Baltimore, MD 21205

The feasibility of clinical heart-lung transplantation requires a better understanding of the physiological consequences of the operation, heart-lung denervation, and the quality of graft preservation. An acute canine model was used to evaluate heart-lung function during the first 24 hours after transplantation.

Measurements of cardiopulmonary dynamics were performed in 5 donor animals and compared sequentially after transplantation in the respective recipients. Orthotopic allotransplantation was performed on cardiopulmonary bypass with moderate hypothermia after perfusion of both the heart and lung with a clinical cardioplegic solution (4°C; potassium chloride, 30 mEq/L; mannitol, 20 gm/L). Postoperatively, the animals were ventilated continuously and anesthetized. Hemodynamic variables were monitored, and measurements were made of arterial and venous oxygen, carbon dioxide, saturation, and pulmonary mechanics. Cardiac output and a derived measurement of lung water were determined. Pulmonary vascular resistance, arteriovenous shunt, resistance, and compliance were calculated.

At the termination of the experiment, significant differences were observed between donor and recipient lung-water levels (7.7 ± 0.9 ml/kg versus 12.0 ± 3.1 ml/kg, respectively; p < 0.05); 100% arterial oxygen tension (509 ± 37 mm/Hg versus 227 ± 114 mm/Hg, respectively; p < 0.01); and pulmonary compliance (38 ± 18 ml/cm H₂O versus 11 ± 4 ml/cm H₂O, respectively; p < 0.05). Arteriovenous shunt increased from 12.2 ± 4 to 16.5 ± 5% (p = 0.2).

This model evaluates the technique currently employed clinically and will be used in the future to compare methods of heart-lung preservation with the goal of allowing distant heart-lung procurement.

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