The use of a prostacyclin analog, iloprost, as an adjunct to pulmonary preservation with Euro-Collins solution.

The addition of prostaglandin to the single-flush technique of lung preservation is considered to enhance subsequent graft function. We have evaluated the use of the prostacyclin analog, Iloprost, in an animal model of unilateral lung transplantation. Group 1 (n = 5) received Iloprost as a pretreatment intravenously (20 ng/kg/min) and as an additive (20 ng/L) to 20 ml/kg of modified Euro-Collins solution. Group 2 (n = 5) received no Iloprost, either as pretreatment or added to the perfusate. Perfusate distribution within the lungs during flush perfusion was assessed using 99mTc-labelled microaggregates of albumin. After the initial preservation technique the lungs in both groups were stored for 6 hr in Euro-Collins solution at 4 degrees C. Thereafter, left lung transplantation was followed by ligation of the contralateral pulmonary artery and bronchus, rendering the animal completely dependent on the transplanted, stored lung. Preservation was assessed by animal survival, measurement of hemodynamic and blood gas data for 24 hr at a fixed FiO2 (0.4) and tidal volume (10 ml/kg), and at sacrifice by measurement of transplanted lung water. By these criteria, both group 1 and 2 lungs were well preserved. The addition of Iloprost to group 1 animals appeared to confer no measureable benefit in terms of lung cooling, perfusate distribution, postoperative graft function, or total lung water.

Surgical management of carcinoid heart disease.

Metastatic carcinoid tumor is often seen with flushing, diarrhea, and cardiac symptoms--the carcinoid syndrome. Cardiac failure is often associated with major morbidity and mortality in carcinoid disease. In this report, a case of successful cardiac valvar surgical intervention has resulted in prolonged alleviation of cardiac symptoms and survival.

Successful use of left ventricular assist device for primary graft failure after heart transplantation.

A 52-year-old man underwent orthotopic heart transplantation, which was complicated by primary, donor organ failure. This was successfully managed by mechanical left ventricular assistance with a centrifugal pump. The patient subsequently made an uneventful and complete recovery, with normal graft function. Reasons for graft failure are discussed.

Techniques and results in bilateral sequential single lung transplantation. The National Heart & Lung Replacement Service.

Lung transplantation continues to evolve as a therapeutic option for patients with end-stage lung disease. Bilateral sequential single lung transplantation (BSSLTx) is a recent addition to the lung transplant surgeon's armamentarium that incorporates the benefits of single lung transplantation in patients who require double lung replacement while avoiding the morbidity inherent in the en bloc double lung transplant procedure. Between November 1992 and October 1993, 17 recipients underwent 18 bilateral BSSLTx procedures for a variety of indications. In 53% of patients, the procedure was completed without the requirement for cardiopulmonary bypass. Telescoping of the bronchial anastomosis has proved satisfactory. Induction cytolytic therapy has not been utilized. Patients received methyl prednisolone from day 1 and as maintenance prednisolone therapy. Actuarial 1-year survival is 87%; 12 of the 15 survivors are in Functional Class I. BSSLTx is an evolving transplant option for patients who require double lung replacement. Definitive clinical diffusion of the procedure will depend upon intermediate and long-term outcomes for specific recipient pathologies.