European Journal of Cardio-Thoracic Surgery, Vol 4, 219-223, Copyright © 1990 by European Association for Cardio-thoracic Surgery
Combined lung and heart extraction in clinical transplantation
JP Duchatelle, A Giudicelli, S Bouttier, O Nussaume, M Kitzis and B Andreassian
Department of Thoracic and Vascular Surgery, Hospital Beaujon, Clichy, France.
The anatomical conditions for single lung and double lung transplantation
allow a heart transplant and one or two lung transplants to be performed in
two or three different recipients from a single donor with healthy lungs.
The extraction of the heart and lung block for the purposes of these
separate transplantations is described on the basis of our experience of 6
single lung transplants with 6 extractions for cardiac transplantation in
different recipients, of a total of 8 lung transplants. We report these 12
successful operations and the particular technical modalities of
cardiopulmonary extraction for separate transplantation. After cannulation
for cooling of the abdominal viscera (kidneys, liver, pancreas), thoracic
and mediastinal dissection, cardioplegia and surface pulmonary cooling by
iced saline on the collapsed lungs, the heart and lungs were extracted as a
single block and were separated ex situ. After periods of cold ischaemia of
1 h to 3 h 30 min for the hearts and 1 h 30 min to 5 h for the lungs, the
immediate and medium term functions were satisfactory. Logistical
difficulties involved in matching the population of recipients have
prevented the grafting of three different recipients up until now. These
successes make it essential to preserve the lungs from donors with healthy
lungs. A rigorous coordination between the various transplantation teams
helps to avoid competition between the three types of transplantation:
heart-lung, double lung and single lung.
