HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ulf Herold Heinz Jakob Markus Kamler Siegfried Hagl Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Herold, U. Articles by Hagl, S. Search for Related Content PubMed PubMed Citation Articles by Herold, U. Articles by Hagl, S.

Eur J Cardiothorac Surg 1998;13:176-183
© 1998 Elsevier Science NL

Interruption of bronchial circulation leads to a severe decrease in peribronchial oxygen tension in standard lung transplantation technique¹

^a Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
^b Department of Anaesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
^c Department of Experimental Surgery, University of Heidelberg, Im Neuenheimer Feld 366, 69120 Heidelberg, Germany

Received 20 January 1997; received in revised form 30 November 1997; accepted 9 December 1997.

Corresponding author. Tel.: +49 6221 566487; fax: +49 6221 565585.

Objective: In clinical practice lung transplantation is the only procedure where the transplanted organ is left without its own arterial perfusion. With the interruption of the bronchial arteries the nutritive support is dependent on collateral flow by the pulmonary artery and the oxygen tension of desaturated central venous blood, representing an abnormal physiology. Methods: To analyze this problem systematically, we used a standard single left lung transplantation model in the pig (n=12). In accordance with the clinical standard, lung preservation was performed with modified Euro-Collins solution with addition of prostacycline. The duration of ischemia was set to 4 h. Before and after single left lung transplantation tissue oxygen tension in the peribronchial tissue was measured with Licox® tissue pO₂ microprobes. For validation, the myocardial tissue oxygen tension was recorded simultaneously. The hemodynamic assessment included continuous flow measurement of the left and right pulmonary artery using Transsonic ultrasound flow probes. After transplantation the animals were observed for 4 h. For hypothetic augmentation of collateral blood flow to the peribronchial tissue we administered Nitric oxide (10 ppm) to the ventilation in six pigs (group B). Six pigs (group A) served as a control without the addition of nitric oxide (NO). All pigs were ventilated with a FiO₂ of 0.5 resulting in paO₂ values between 160 and 200 mmHg. Results: In both groups single lung transplantation led to a significant decrease in peribronchial tissue oxygen tension throughout the observation period. Pre-Tx values of peribronchial tissue oxygen tension (38.31±6.56 mmHg) decreased to 9.72±2.55 mmHg in group A and 10.3±3.61 mmHg in group B after 4 h, which could not be altered by a FiO₂ of 1.0 (P<0.0001). The addition of NO in group B led to a significantly augmented flow in the left pulmonary artery (0.63±0.31 l/min in group B vs. 0.46±0.26 l/min group A, P<0.001) representing 67 vs. 49% of the pre-Tx flow in groups B and A, respectively, but the peribronchial tissue oxygen tension was not influenced (P>0.05). In both groups A and B, the central venous pO₂ did not differ in the postoperative period (41.83±3.27 mmHg group A vs. 43.26±2.98 mmHg group B) and was kept in a comparable range to the pretransplantation values (45.23±3.41 mmHg pre-Tx). Conclusions: The persistence of a very low peribronchial tissue oxygen tension in the early phase after lung transplantation cannot be influenced by improved pulmonary artery flow and solely relates to the central venous pO₂, which cannot be augmented by the addition of NO. This mechanism might be a trigger for anastomotic healing problems, infectious complications and later development of obliterative bronchiolitis (OB).

Key Words: Lung transplantation • Tissue oxygen measurement • Bronchial ischemia • Hypoxia

This article has been cited by other articles:

				M. G. Saueressig, A. M. Neto, E. A.F. Fortis, D. Westphal, M. I.A. Edelweiss, L. Meurer, and U. Matte Vascular endothelial growth factor gene therapy induces early re-establishment of canine bronchial circulation Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 717 - 722. [Abstract] [Full Text] [PDF]

				N. Juul, H. Jensen, M. Hvid, G. Christiansen, and S. Birkelund Characterization of In Vitro Chlamydial Cultures in Low-Oxygen Atmospheres J. Bacteriol., September 15, 2007; 189(18): 6723 - 6726. [Abstract] [Full Text] [PDF]

				F. H. Y. Green, J. C. Butt, A. L. James, and N. G. Carroll Abnormalities of the bronchial arteries in asthma. Chest, October 1, 2006; 130(4): 1025 - 1033. [Abstract] [Full Text] [PDF]

				K. NOWAK, M. KAMLER, M. BOCK, J. MOTSCH, S. HAGL, H. JAKOB, and M.-M. GEBHARD Bronchial Artery Revascularization Affects Graft Recovery after Lung Transplantation Am. J. Respir. Crit. Care Med., January 15, 2002; 165(2): 216 - 220. [Abstract] [Full Text] [PDF]