METHODS FOR LUNG DOWNSIZING AS SURGICAL INTERVENTIONS DURING EX VIVO LUNG PERFUSION IN A NEW CUSTOM-MADE MODEL

• Published in: International journal of artificial organs 2019-08, Vol.42 (8)
• Main Authors: Nubbemeyer, K, Steffen, H, Kalverkamp, S, Autschbach, R, Spillner, J, Drosos, V
• Format: Article
• Language: English
• Subjects: Air leakage; Autografts; Bleeding; Blood; Blood pressure; Circuits; Cost assessments; Downsizing; Experimental research; Feasibility; Feasibility studies; Gas analysis; Low cost; Lung transplantation; Lungs; Organ removal; Oxygenation; Parenchyma; Perfusion; Pulmonary arteries; Pulmonary artery; Swine; Transplantation; Wedges
• ISSN: 0391-3988; 1724-6040

Ex vivo lung perfusion (EVLP) is a technique to evaluate lungs before transplantation. As a tool for experimental research, this method allows organ modification and assessment. However, the costs are high. The aim of this study was to establish a low-cost EVLP model on the one hand and to investigate the feasibility of surgical graft downsizing during EVLP on the other hand. We compared a lobectomy, a stapled wedge and a sutured wedge resection during EVLP. Pigs of 60 kg weight were used for organ harvesting. After cardiac death lungs were retrieved, flushed with Perfadex and perfused with autologous blood for 4 hours of EVLP. The circuit was assembled from an ECMO system consisting of a Deltastream DP2 pump (Medos), an Affinity Fusion oxygenator (Medtronic) and a hardshell reservoir. After 90 minutes of perfusion a lobectomy was performed. At intervals of 30 minutes, a stapled wedge resection and a sutured wedge resection were performed. Air leak and the loss of blood were measured. The function of the lung was monitored including pulmonary artery pressure and blood gas analysis. 20 porcine lungs were used to establish a stable model. Another 7 lungs underwent surgical interventions. The blood loss after lobectomy (3,14 ± 4,14 ml/min) and after stapled wedge resection (5,29 ± 8,1 ml/min) was lower than after sutured wedge resection (33 ± 17,36 ml/min). There was no major difference in air leak after the surgical interventions (lobectomy: 0,06 ± 0,16 l/min vs. stapler: 0,03 ± 0,09 l/min vs. suture: 0,04 ± 0,1 l/min). The oxygenation performance was satisfactory. The pulmonary artery pressure was in a physiological range. Bleeding into the parenchyma after suture was higher compared to the other interventions. The low-cost custom-made EVLP model presented here is feasible and stable. Surgical interventions during EVLP are possible. Performing a lobectomy and a wedge resection is superior to a wedge resection with suture regarding to the blood loss.