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Ann Thorac Surg 1988;46:553-555
© 1988 The Society of Thoracic Surgeons

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Articles

Donor Deep Hypothermia or Donor Pretreatment with Prostaglandin E₁ and Single Pulmonary Artery Flush for Heart-Lung Graft Preservation: An Experimental Primate Study

Department of Cardiovascular Surgery, Stanford University Medical Center, Stanford, CA

Accepted for publication June 9, 1988.

^* Address reprint requests to Dr. Harjula, Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, SF-00290 Helsinki, Finland

Using cardiopulmonary bypass to cool the graft and flushing the lungs with cold crystalloid solution are the most popular methods for clinical cardiopulmonary preservation. Heart-lung transplantation was carried out in 11 cynomolgus monkeys. Donor cardiac preservation was achieved with cold crystalloid cardioplegic solution (10 ml per kilogram of body weight) in all animals. Lung preservation was achieved with a rollerhead pump and by cooling (12°C) the donor in one group of 4 animals (deep hypothermia group) and infusing cold (4°C) modified Euro-Collins solution (15 ml/kg x 4 minutes) into the main pulmonary artery of 7 donors pretreated with prostaglandin E₁ (PGE₁) (PGE₁ group). PGE₁ was given intravenously (0.5 to 4.0 µg/kg/min) beginning 15 minutes prior to aortic cross-clamping and was continued during administration of the pulmonary cooling solution. In the deep hypothermia group, no pharmacotherapy was used. Grafts were stored at 4°C for about 6 hours. After heart-lung transplantation, arterial blood gases were measured on 40% inspired oxygen and 2 to 3 cm of positive end-expiratory pressure, and were significantly higher in the PGE₁ group than the deep hypothermia group after 8 hours of reperfusion (p = 0.04).

The partial pressure of arterial oxygen decreased significantly during the 8 hours of reperfusion in the deep hypothermia group (153 to 108 mm Hg; p = 0.01) and increased in the PGE₁ group (189 to 218 mm Hg; p = 0.0002). Eighty-six percent of the animals in the PGE₁ group survived more than 24 hours (p = 0.03). There were no survivors in the deep hypothermia group. These results indicate that PGE₁ and single hypothermic flush yielded significantly better cardiopulmonary function and survival than pumping the donors into hypothermia with a roller-head pump.

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