Downing T P, Sadeghi A M, Baumgartner W A, Reitz B A, Brackup A, Feeley T, Mihm F, Shumway N E
Ann Thorac Surg. 1984 Jun;37(6):479-83. doi: 10.1016/s0003-4975(10)61135-6.
The feasibility of clinical heart-lung transplantation requires a better understanding of the physiological consequences of the operation, heart-lung denervation, and the quality of graft preservation. An acute canine model was used to evaluate heart-lung function during the first 24 hours after transplantation. Measurements of cardiopulmonary dynamics were performed in 5 donor animals and compared sequentially after transplantation in the respective recipients. Orthotopic allotransplantation was performed on cardiopulmonary bypass with moderate hypothermia after perfusion of both the heart and lung with a clinical cardioplegic solution (4 degrees C; potassium chloride, 30 mEq/L; mannitol, 20 gm/L). Postoperatively, the animals were ventilated continuously and anesthetized. Hemodynamic variables were monitored, and measurements were made of arterial and venous oxygen, carbon dioxide, saturation, and pulmonary mechanics. Cardiac output and a derived measurement of lung water were determined. Pulmonary vascular resistance, arteriovenous shunt, resistance, and compliance were calculated. At the termination of the experiment, significant differences were observed between donor and recipient lung-water levels (7.7 +/- 0.9 ml/kg versus 12.0 +/- 3.1 ml/kg, respectively; p less than 0.05); 100% arterial oxygen tension (509 +/- 37 mm/Hg versus 227 +/- 114 mm/Hg, respectively; p less than 0.01); and pulmonary compliance (38 +/- 18 ml/cm H2O versus 11 +/- 4 ml/cm H2O, respectively; p less than 0.05). Arteriovenous shunt increased from 12.2 +/- 4 to 16.5 +/- 5% (p = 0.2). This model evaluates the technique currently employed clinically and will be used in the future to compare methods of heart-lung preservation with the goal of allowing distant heart-lung procurement.
临床心肺移植的可行性需要更好地了解手术的生理后果、心肺去神经支配以及移植物保存质量。使用急性犬模型评估移植后最初24小时内心肺功能。在5只供体动物中进行心肺动力学测量，并在移植后在各自受体中进行顺序比较。在心肺灌注临床心脏停搏液（4℃；氯化钾，30mEq/L；甘露醇，20g/L）后，在中度低温体外循环下进行原位同种异体移植。术后，动物持续通气并麻醉。监测血流动力学变量，并测量动脉和静脉血氧、二氧化碳、饱和度以及肺力学。测定心输出量和肺水的衍生测量值。计算肺血管阻力、动静脉分流、阻力和顺应性。在实验结束时，观察到供体和受体肺水水平之间存在显著差异（分别为7.7±0.9ml/kg和12.0±3.1ml/kg；p<0.05）；动脉血氧张力为100%（分别为509±37mmHg和227±114mmHg；p<0.01）；以及肺顺应性（分别为38±18ml/cm H2O和11±4ml/cm H2O；p<0.05）。动静脉分流从12.2±4增加到16.5±5%（p = 0.2）。该模型评估了目前临床上采用的技术，未来将用于比较心肺保存方法，目标是实现远距离心肺获取。
