Huerd S S, Hodges T N, Grover F L, Mault J R, Mitchell M B, Campbell D N, Aziz S, Chetham P, Torres F, Zamora M R
Divisions of Cardiothoracic Surgery, Pulmonary Medicine, and Anesthesiology, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
J Thorac Cardiovasc Surg. 2000 Mar;119(3):458-65. doi: 10.1016/s0022-5223(00)70124-3.
Primary and secondary pulmonary hypertension have been associated with poor outcomes after single lung transplantation. Some groups advocate double lung transplantation and the routine use of cardiopulmonary bypass during transplantation in this population. However, the optimal procedure for these patients remains controversial. The goal of our study was to determine the safety of single lung transplantation without cardiopulmonary bypass in patients with secondary pulmonary hypertension.
We retrospectively reviewed 76 consecutive patients with pulmonary parenchymal disease who underwent single lung transplantation from 1992 to 1998. Recipients were stratified according to preoperative mean pulmonary artery pressure. Secondary pulmonary hypertension was defined as parenchymal lung disease with a preoperative mean pulmonary artery pressure of 30 mm Hg or more. Patients with primary pulmonary hypertension or Eisenmenger's syndrome were excluded from analysis.
Eighteen of 76 patients had secondary pulmonary hypertension. No patient with secondary pulmonary hypertension required cardiopulmonary bypass, whereas 1 patient without pulmonary hypertension required bypass. After the operation, no significant differences were seen in lung injury as measured by chest radiograph score and PaO(2)/FIO(2) ratio, the requirement for inhaled nitric oxide, the length of mechanical ventilation, the intensive care unit or hospital length of stay, and 30-day survival. There were no differences in the forced expiratory volume in 1 second or 6-minute walk at 1 year, or the incidence of rejection, infection, or bronchiolitis obliterans syndrome greater than grade 2. Survival at 1, 2, and 4 years after transplantation was 86%, 79%, and 65%, respectively, in the low pulmonary artery pressure group and 81%, 81%, and 61%, respectively, in the group with secondary pulmonary hypertension (P >.2).
We found that patients with pulmonary parenchymal disease and concomitant secondary pulmonary hypertension had successful outcomes as measured by early and late allograft function and appear to have acceptable long-term survival after single lung transplantation. Our results do not support the routine use of cardiopulmonary bypass or double lung transplantation for patients with this disorder.
原发性和继发性肺动脉高压与单肺移植术后预后不良相关。一些研究小组主张对此类患者进行双肺移植，并在移植过程中常规使用体外循环。然而，针对这些患者的最佳手术方式仍存在争议。我们研究的目的是确定在继发性肺动脉高压患者中不使用体外循环进行单肺移植的安全性。
我们回顾性分析了1992年至1998年间连续接受单肺移植的76例肺实质疾病患者。根据术前平均肺动脉压对受者进行分层。继发性肺动脉高压定义为术前平均肺动脉压≥30 mmHg的肺实质疾病。原发性肺动脉高压或艾森曼格综合征患者被排除在分析之外。
76例患者中有18例患有继发性肺动脉高压。没有继发性肺动脉高压患者需要体外循环，而1例无肺动脉高压患者需要体外循环。术后，通过胸部X线评分和PaO₂/FIO₂比值测量的肺损伤、吸入一氧化氮的需求、机械通气时间、重症监护病房或住院时间以及30天生存率方面均无显著差异。1年时第1秒用力呼气量或6分钟步行距离、排斥反应、感染或大于2级的闭塞性细支气管炎综合征发生率也无差异。移植后1年、2年和4年的生存率，肺动脉压较低组分别为86%、79%和65%，继发性肺动脉高压组分别为81%、81%和61%（P>.2）。
我们发现，肺实质疾病合并继发性肺动脉高压的患者，从早期和晚期移植肺功能来看，手术结果良好，单肺移植后似乎有可接受的长期生存率。我们的结果不支持对此类患者常规使用体外循环或双肺移植。
