Importance of left atrial pressure during ex vivo lung perfusion

Virginia Linacre, Marcelo Cypel, Tiago Machuca, Daisuke Nakajima, Kohei Hashimoto, Ricardo Zamel, Manyin Chen, Ilker Iskender, Pedro Dos Santos, Thomas K. Waddell, Mingyao Liu, Shaf Keshavjee

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Background Ex vivo lung perfusion (EVLP) allows for the evaluation and treatment of donor lungs before transplant. Different EVLP strategies have been described using either an open left atrium (LA) (pressure of 0 mm Hg) or closed LA (pressure of 5 mm Hg). We hypothesized that maintaining a physiologic positive LA pressure during EVLP is protective to the lung. Methods Pig lungs were flushed with Perfadex, retrieved and stored at 4°C for 4 hours [short cold ischemic time (CIT), n = 10] or 18 hours (prolonged CIT, n = 8). Subsequently, lungs underwent normothermic EVLP for 12 hours using either an open or closed LA technique. A linear mixed effect model was used to compare functional parameters between the 2 groups. Results After short CIT, 12-hour EVLP could not be completed in 4 of 5 open atrium cases due to significant pulmonary edema. Lung injury was evident in this group after 7 hours of EVLP, demonstrating an increase in pulmonary vascular resistance (p < 0.001) and peak inspiratory pressure (p = 0.001), and a decrease in lung compliance (p < 0.001) and perfusate oxygenation (p = 0.04). In contrast, in the closed atrium group, all lungs completed 12 hours of EVLP with stable functional parameters. At the end of the experiment, the wet/dry ratio (p = 0.015) and lung edema score (p = 0.02) were significantly worse in the open LA group compared with the closed LA EVLP group. Similar findings were observed in the prolonged CIT group. Conclusion The use of a closed atrial technique to create a controlled positive LA during EVLP leads to significantly less edema and superior lung physiology.

元の言語English
ページ(範囲)808-814
ページ数7
ジャーナルJournal of Heart and Lung Transplantation
35
発行部数6
DOI
出版物ステータスPublished - 2016 6 1
外部発表Yes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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    Linacre, V., Cypel, M., Machuca, T., Nakajima, D., Hashimoto, K., Zamel, R., Chen, M., Iskender, I., Dos Santos, P., Waddell, T. K., Liu, M., & Keshavjee, S. (2016). Importance of left atrial pressure during ex vivo lung perfusion. Journal of Heart and Lung Transplantation, 35(6), 808-814. https://doi.org/10.1016/j.healun.2016.02.008