Transplantation of lungs from non–heart-beating donors after functional assessment ex vivo Stig Steen, MD, PhD, Qiuming Liao, MD, Per N Wierup, MD, Ramunas.

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Transplantation of lungs from non–heart-beating donors after functional assessment ex vivo Stig Steen, MD, PhD, Qiuming Liao, MD, Per N Wierup, MD, Ramunas Bolys, MD, Leif Pierre, CCP, Trygve Sjöberg, PhD The Annals of Thoracic Surgery Volume 76, Issue 1, Pages 244-252 (July 2003) DOI: 10.1016/S0003-4975(03)00191-7

Fig 1 Topical cooling of lungs in situ. (A) After the first pair of Perfadex bags (1) have been emptied into the pleural space on each side, (B) a second pair of bags (2) are infused, while the first pair (1) are immersed in ice water in containers placed so that the water surface is 5 cm higher than the most anterior part of the thorax cavity. By switching every time the infusion bags are empty, an efficient cooling is obtained. It is important that the tracheal tube is open to the air during these procedures. (C = spinal column; LL = left lung; RL = right lung.) The Annals of Thoracic Surgery 2003 76, 244-252DOI: (10.1016/S0003-4975(03)00191-7)

Fig 2 Assessment of lung function ex vivo. (A) Schematic of the evaluation system. (temp. = temperature.) (B) The heart-lung block is placed in the evaluation box ready for cannulation. The Annals of Thoracic Surgery 2003 76, 244-252DOI: (10.1016/S0003-4975(03)00191-7)

Fig 3 When the temperature of the blood coming out from the lungs is 32°C, ventilation of the lungs is initiated. At 37°C, full flow is run with a maximal mean pulmonary arterial pressure of 20 mm Hg. The lungs are ventilated with an inspired oxygen fraction varying between 0.21 and 1.0, with a respiratory minute volume 2.5 times the perfusion flow, and with a positive end-expiratory pressure of 5 to 8 cm H2O. After the evaluation, topical extracorporeal membrane oxygenation is performed within the same container. The Annals of Thoracic Surgery 2003 76, 244-252DOI: (10.1016/S0003-4975(03)00191-7)

Fig 4 Topical cooling of lungs. The intraluminal bronchial temperature probe was introduced through the tracheal tube deep into the bronchial tree. Mean ± SEM, n = 6. The Annals of Thoracic Surgery 2003 76, 244-252DOI: (10.1016/S0003-4975(03)00191-7)

Fig 5 Ex vivo assessment of lung hemodynamics. Mean ± SEM, n = 6. (LAP = left arterial pressure; MPAP = mean pulmonary artery pressure; PVR = pulmonary vascular resistance.) The Annals of Thoracic Surgery 2003 76, 244-252DOI: (10.1016/S0003-4975(03)00191-7)

Fig 6 Blood gases during the first 24 hours of reperfusion. Right pneumonectomy was done after 6 hours. Inspired oxygen fraction = 0.5. Mean ± SEM, n = 6. (PaO2 = arterial oxygen pressure [tension]; PvO2 = venous oxygen pressure [tension]; SaO2 = arterial oxygen percent saturation; SvO2 = mixed venous oxygen percent saturation.) The Annals of Thoracic Surgery 2003 76, 244-252DOI: (10.1016/S0003-4975(03)00191-7)

Fig 7 Hemodynamics during the first 24 hours of reperfusion. Thermodilution (Swan-Ganz catheter) was used to calculate cardiac output during the first 6 hours. Right pneumonectomy was done after 6 hours, after which the cardiac output was measured continuously through a flow probe on the left pulmonary artery. Mean ± SEM, n = 6. (LAP = left arterial pressure; MAP = mean arterial pressure; MPAP = mean pulmonary artery pressure; PVR = pulmonary vascular resistance; SVR = systemic vascular resistance.) The Annals of Thoracic Surgery 2003 76, 244-252DOI: (10.1016/S0003-4975(03)00191-7)