Cardiopulmonary bypass for bilateral sequential lung transplantation in patients with chronic obstructive pulmonary disease without adverse effect on lung function or clinical outcome.
OBJECTIVE
The use of cardiopulmonary bypass in lung transplantation remains controversial. Previous studies have concluded that cardiopulmonary bypass is deleterious, but these studies were confounded by the inclusion of patients with different diagnoses undergoing single- and double-lung transplantation with elective or emergency use of bypass. The goal of this study was to determine whether cardiopulmonary bypass has deleterious effects on lung function or clinical outcome by analyzing the cases of patients with a single disease entity and elective use of bypass for bilateral sequential lung transplantation.


METHODS
A retrospective review of 50 patients with chronic obstructive pulmonary disease who underwent bilateral sequential lung transplantation was performed. Fourteen patients who underwent elective cardiopulmonary bypass for 218.3 +/- 75.4 minutes were compared to 36 control patients.


RESULTS
After the operation, the bypass and nonbypass groups were not significantly different with respect to median duration of mechanical ventilation (1 day vs 1 day, P =.76), median stay in the intensive care unit (4 days vs 4 days, P =.44), median hospital stay (15.5 days vs 16 days, P =.74), mean increase in serum creatinine level (1.4 +/- 1.9 mg/dL vs 0.9 +/- 1.0 mg/dL, P =.33), and mean ratio of Pao(2) to fraction of inspired oxygen at 1 hour (376.6 +/- 123 vs 357.0 +/- 218, P =.75), at 24 hours (309.9 +/- 92 vs 350.6 +/- 122, P =.26), and at 48 hours (335.0 +/- 144 vs 316.2 +/- 120, P =.64). Late outcome markers compared between the bypass and nonbypass groups were the following: 1-year percentage predicted forced expiratory volume in 1 second (76.1% +/- 17.0% vs 85.3% +/- 21.7%, P =.24), 30-day mortality (7.1% vs 8.3%, P >.999), 1-year survival (85.7% vs 80.1%, P =.66), 3-year survival (64.3% vs 58.3%, P =.70), and the prevalence of bronchiolitis obliterans syndrome (0% vs 36.1%, P =.01).


CONCLUSIONS
Cardiopulmonary bypass appears to have no deleterious effect on early lung function or clinical outcome. We hope that this pilot study removes some of the unwarranted fear of the use of bypass in lung transplantation for chronic obstructive pulmonary disease.
Szeto
Wilson Y
WY
Department of Surgery, Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Kreisel
Daniel
D
Karakousis
Giorgos C
GC
Pochettino
Alberto
A
Sterman
Daniel H
DH
Kotloff
Robert M
RM
Arcasoy
Selim M
SM
Zisman
David A
DA
Blumenthal
Nancy P
NP
Gallop
Robert J
RJ
Kaiser
Larry R
LR
Bavaria
Joseph E
JE
Rosengard
Bruce R
BR
D000704:Analysis of Variance; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000601:surgery*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome