title: Cardiopulmonary bypass during a second-lung implantation improves postoperative oxygenation after sequential double-lung transplantation.
abstract: OBJECTIVE
  During sequential double-lung transplantation (DLT), the newly implanted first lung receives the entire cardiac output during the implantation of the second one. This may be responsible for the increased hydrostatic pressure that causes severe interstitial and alveolar edema that can lead to allograft dysfunction. The authors tested the hypothesis that CPB started after first graft implantation and before second recipient lung removal should improve post-transplantation oxygenation and clinical outcomes.
  
  
  METHODS
  Observational during 2 consecutive 1-year periods.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Nine consecutive patients undergoing sequential DLT with CPB started after first graft implantation and before second recipient lung removal were compared to controls, who were 10 consecutive patients who underwent sequential DLT but without CPB the year before.
  
  
  RESULTS
  Oxygenation after transplantation was assessed. The use of CPB during the implantation of the second lung was associated with an increased mean postoperative ratio of PaO2 to the fraction of inspired oxygen at 1 hour (363±51 v 240±113, p = 0.01) and 6 hours (430±111 v 280±103, p = 0.03). The mean duration of CPB was 111±19 min. The occurrence of primary graft dysfunction and the need for extracorporeal membrane oxygenation tended to be lower, but did not reach significance. Similarly, mortality rate was comparable between both groups, as was the rate of blood transfusions.
  
  
  CONCLUSIONS
  The authors' results suggest that the use of CPB started after first graft implantation and before second recipient lung removal appears to benefit oxygenation and reduces the occurrence of severe pulmonary edema in the first transplanted lung.
authors.affiliation: CHU de Bordeaux, Service d'Anesthésie-Réanimation II, Pessac, France. hadrien.roze@chu-bordeaux.fr
authors.forename: Hadrien
authors.initials: H
authors.lastname: Rozé
authors.forename: Matthieu
authors.initials: M
authors.lastname: Thumerel
authors.forename: Laurent
authors.initials: L
authors.lastname: Barandon
authors.forename: Claire
authors.initials: C
authors.lastname: Dromer
authors.forename: Virginie
authors.initials: V
authors.lastname: Perrier
authors.forename: Jacques
authors.initials: J
authors.lastname: Jougon
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Velly
authors.forename: Alexandre
authors.initials: A
authors.lastname: Ouattara
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011184:Postoperative Period; D011652:Pulmonary Circulation / Q000502:physiology; D015427:Reperfusion Injury / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome