Cardiopulmonary bypass is associated with early allograft dysfunction but not death after double-lung transplantation.
OBJECTIVE
To assess the effect of cardiopulmonary bypass on allograft function and recipient survival in double-lung transplantation.


METHODS
Retrospective review of 94 double-lung transplantations.


RESULTS
Cardiopulmonary bypass was used in 37 patients (CPB); 57 transplantations were accomplished without bypass (no-CPB). Bypass was routinely used for patients with pulmonary hypertension (n = 27) and for two recipients undergoing en bloc transplantation. Cardiopulmonary bypass was required in eight (12.3%) of the remaining 65 patients. Mean ischemic time was longer in the CPB group (346 vs 315 minutes, p = 0.04). The CPB group required more perioperative blood (11.4 vs 6.0 units, p = 0.01). Allograft function, assessed by the arterial/alveolar oxygen tension ratio, was better in the no-CPB group at 12 and 24 hours after operation (0.54 vs 0.39 at 12 hours, p = 0.002; and 0.63 vs 0.38 at 24 hours, p = 0.001). The CPB group had more severe pulmonary infiltrates at both 1 and 24 hours (p = 0.005). Diffuse alveolar damage was more common in the CPB group (69% vs 35%, p = 0.002). Median duration of intubation was longer in the CPB group (10 days) than in the no-CPB group (2 days, p = 0.002). The 30-day mortality rate (13.5% vs 7.0% in the CPB and no-CPB groups) and 1-year survival (65% vs 67%, CPB and no-CPB) were not significantly different.


CONCLUSIONS
In the absence of pulmonary hypertension, cardiopulmonary bypass is only occasionally necessary in double-lung transplantation. Bypass is associated with substantial early allograft dysfunction after transplantation.
Gammie
J S
JS
Division of Cardiothoracic Surgery, The University of Pittsburgh Medical Center, PA, USA.
Cheul Lee
J
J
Pham
S M
SM
Keenan
R J
RJ
Weyant
R J
RJ
Hattler
B G
BG
Griffith
B P
BP
D000293:Adolescent; D000328:Adult; D001999:Bronchoscopy; D002315:Cardiopulmonary Bypass; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D011669:Pulmonary Wedge Pressure; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000401:mortality / Q000502:physiology