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The Annals of Thoracic Surgery, Vol 57, 715-722, Copyright © 1994 by The Society of Thoracic Surgeons
R Aeba, BP Griffith, RL Kormos, JM Armitage, TA Gasior, CR Fuhrman, SA Yousem and RL Hardesty
The records of 100 lung transplant recipients (13 heart-lungs, 45
double-lungs, and 42 single-lungs) from September 1990 through April 1992
were reviewed to determine the role of cardiopulmonary bypass (CPB) in
early graft dysfunction. Fifty-five patients requiring CPB (CPB group) for
186 +/- 54 minutes were compared with the 45 patients without CPB (no-CPB
group). All of the heart-lung and en-bloc double- lung transplantations
were performed under CPB, with pulmonary vascular lung disease the
principal diagnosis, resulting in a significantly younger age population in
the CPB group. All other donor- and recipient- related factors matched well
in both groups. Of 38 bilateral single- lung transplantations, CPB was used
in 18. In double-lung and heart- lung recipients gas exchange of the
allografts was evaluated by the arterial/alveolar oxygen tension ratios at
nine intervals during the first 72 hours. The mean arterial/alveolar oxygen
tension ratio in the CPB group was 0.48 +/- 0.19, significantly lower than
in the no-CPB group with 0.60 +/- 0.22 (p = 0.025). All patients had
radiographic interpretation and scoring of pulmonary infiltrates from chest
roentgenograms taken within 12 hours after reperfusion. The CPB group had
more severe pulmonary infiltrates than the no-CPB group (p = 0.034).
Prolonged intubation defined as 7 days or longer occurred significantly
more often (29/55) in the CPB group than in the no-CPB group (8/45) (p =
0.003). Actuarial graft and patient survival at 1 month was better in the
no-CPB group than in the CPB group (42/45 versus 44/55 [p = 0.05] and 43/45
versus 45/55 [p = 0.033], respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Effect of cardiopulmonary bypass on early graft dysfunction in clinical lung transplantation
Division of Cardiothoracic Surgery, University of Pittsburgh, Pennsylvania.
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