Core-cooling, heart-perfusion, lung-immersion technique provides successful cardiopulmonary preservation for heart-lung transplantation.

Mongrel dogs underwent heterotopic heart-orthotopic left lung transplantation. In Group I (N = 6), donor organs procured following core cooling to 15 degrees C on cardiopulmonary bypass (CPB) with cardioplegic arrest were immediately transplanted. In Group II (N = 6), following cardioplegic arrest without CPB core-cooling, the pulmonary artery was flushed with modified Collins' solution. Heart-lung blocks were immersed in extracellular solution for 6 hours and then transplanted. In Groups III and IV (N = 6 each), following CPB core-cooling to 15 degrees C and cardioplegic arrest, the organ blocks were immersed in extracellular solution (Group III) and the heart was perfused with oxygenated extracellular solution (Group IV). Evaluation of lung function using differences in arterial oxygen tension between the left and right atria demonstrated no differences between groups. However, extravascular lung water and pulmonary vascular resistance were significantly elevated in Group II. Cardiac function assessed by the ratio of end-systolic pressure to end-systolic dimension was significantly better in Group IV than in Groups II and III. Thus, adequate 6-hour hypothermic cardiopulmonary preservation with core cooling plus heart perfusion can be achieved for heart-lung transplantation.