Importance of left atrial pressure during ex vivo lung perfusion
Section snippets
Animals
Male Yorkshire pigs (25 to 35 kg) were utilized for the experiments. All animals received care in compliance with the “Principles of Laboratory Animal Care,” formulated by the National Society for Medical Research; The Guide for the Care and Use of Laboratory Animals; and the Guide to the Care and Use of Experimental Animals, formulated by the Canadian Council on Animal Care. The animal care committee of the Toronto General Research Institute, University Health Network, approved the
Ability to complete 12 hours of perfusion
All 5 closed atrium cases successfully completed 12 hours of EVLP. In contrast, 4 of 5 cases in the open atrium group could not complete 12 hours of EVLP due to the development of massive edema and complete loss of perfusate volume from the reservoir. Most of these open atrium cases developed edema starting at 7 hours of perfusion. The perfusion times in the open group were 11, 10, 9, 12 and 11 hours, and 45 minutes (recorded as 12-hour time-point), respectively.
Pulmonary physiology
Lung function parameters were
Discussion
In this study we have demonstrated the importance of a positive LA pressure carefully regulated at a physiologic level in a closed circuit to maintain lung integrity during EVLP. The main goal of EVLP is to provide a safe platform for detailed evaluation of donor lungs and, more importantly, to provide a safe means for organ treatment and repair. Different LAP management strategies in EVLP systems have been studied previously. Petak et al13 studied the effects of pulmonary vascular pressure and
Disclosure statement
M.C., S.K. and T.W. are founders of Perfusix, Inc., and XOR Labs, Toronto. Perfusix, Inc., with United Therapeutics Corporation, will provide EVLP services on a commercial basis. The other authors have no conflicts of interest to disclose.
This research was supported by the Canadian Institutes of Health Research (OOP Grant 312227). XVIVO Perfusion (Sweden) provided the Steen Solution and EVLP circuits for this study.
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