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Ann Thorac Surg 2001;72:1189
© 2001 The Society of Thoracic Surgeons

Invited commentary

John H. Calhoon, MDa, Scott B. Johnson, MDa, Edward Y. Sako, MD, PhDa

a Department of Thoracic Surgery, University of Texas Health Science Center, 7703 Floyd Curl Dr, San Antonio, TX 78284-3900, USA

e-mail: calhoon{at}uthscsa.edu

This laboratory study is a significant addition to our evolving understanding of the ischemia/reperfusion response. In our minds it has clinical relevance even as a lab effort. The authors employed delicate microsurgical techniques to effect an elegant rodent model of single lung transplantation. Their mechanism of study seems sound and their results should be similar in other models. Assuming the protective properties of Heparin and N-acetyl-heparin are demonstrated by others in similar models, one could easily translate these results to the clinical arena.

One concern is that N-acetyl-heparin indeed exhibits no anticoagulant properties. Dr Nakamura and colleagues’ most basic finding was that of no-reflow in the control group receiving no heparin substrate at all. If the non-anticoagulant heparin did have anticoagulant activity (something they did screen for) these results could have been explained on that basis. Realizing they did not at autopsy find any "gross thrombosis" may not fully satisfy our concern over this potential issue. Future studies should contain data as to the coagulation status at the various stages of the experiment.

If this concern is indeed invalid then this paper warrants a real change in our thinking. Our algorithm does not always include heparin since the donor receives 30K or 40K units, which probably prevents graft thrombosis. This concern over postoperative bleeding has led us at times to avoid heparin for single lung transplant cases that do not require cardiopulmonary bypass (CPB). Dr Nakamura and associates has shown us that there may well be another benefit of heparin we have overlooked. In fact, most of our single or double single lung transplants that do not require CPB have not had bleeding associated with heparin as much as a lack of prolene, surgical clips, or a diffuse coagulopathy associated with a technically difficult implantation. If these findings are valid, we should use heparin on all of our patients and simply do a better job of drying them up. Further study to help us with necessary dosing and length of dosing for maximum avoidance of the ischemia/reperfusion response is needed as well as clinical corroboration.


Related Article

Heparin and the nonanticoagulant N-acetyl heparin attenuate capillary no-reflow after normothermic ischemia of the lung
Takayuki Nakamura, Brigitte Vollmar, Johannes Winning, Mitsuomi Ueda, Michael D. Menger, and Hans-Joachim Schäfers
Ann. Thorac. Surg. 2001 72: 1183-1189. [Abstract] [Full Text] [PDF]




This Article
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John H. Calhoon
Scott B. Johnson
Edward Y. Sako
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Google Scholar
Right arrow Articles by Calhoon, J. H.
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Right arrow Lung - transplantation
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