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Ryo Aeba
Bartley P. Griffith
Robert L. Kormos
John M. Armitage
Robert L. Hardesty
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Ann Thorac Surg 1994;57:715-722
© 1994 The Society of Thoracic Surgeons

Articles

Effect of cardiopulmonary bypass on early graft dysfunction in clinical lung transplantation

Ryo Aeba, MD*,1, Bartley P. Griffith, MD, Robert L. Kormos, MD, John M. Armitage, MD, Thomas A. Gasior, MD, Carl R. Fuhrman, MD, Samuel A. Yousem, MD, Robert L. Hardesty, MD

Division of Cardiothoracic Surgery and Departments of Anesthesiology, Radiology, and Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania USA

Accepted for publication June 28, 1993.

* Address reprint requests to Dr Aeba, Division of Cardiac Surgery, Department of Surgery, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160, Japan.

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 heartlung and en-bloc double-lung transplantations were petformed 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 ( [equation]) in the CPB group than in the no-CPB group ( [equation]) (p = 0.003). Actuarial graft and patient survival at 1 month was better in the no-CPB group than in the CPB group ( [equation] versus [equation] [p = 0.05] and [equation] versus [equation] [p = 0.033], respectively). These results suggest that the interaction between CPB and preservation injury exaggerates pulmonary dysfunction in clinical lung transplantation.




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