Lung and Heart-Lung Procurement
One of the main factors further limiting increases in the number of lung transplantations is the shortage of donor lungs, and even in the most active centers, the median number of retrieved lungs represents only 15% of all cadaver donors, whereas kidneys and livers are harvested from 88% of donors and hearts are harvested from 30% of deceased donors.Arriving at the hospital where a potential lung donor has been reported, the retrieval team must take the following steps. Chest imaging studies. Gram stains and bronchoscopy findings. Donor age. Gender. Graft ischemic time. Gas exchange.After median sternotomy and cardiac evaluation, the pleural spaces are bilaterally opened without electrocautery to avoid unintentional burn injury to the lungs. It is mandatory to conduct an accurate inspection of the lungs and of the pleural wall for nodules. Every suspicious nodule should be biopsied. Avoid manipulating the sinoatrial area. Do not eviscerate the lungs from the pleural cavity. Direct pneumoplegia cannula toward the pulmonary valve. Incise the left atrial appendage first and the inferior vena cava next to obtain complete decompression of both ventricles; perform this step before the pericardial cavity is flooded by blood vented from the incised inferior vena cava. Cut directly the left atrial appendage without the previous application of a vascular clamp (which carries a risk of lacerating the appendage and damaging the circumflex coronary artery). Just before aortic crossclamping, start prostaglandin E1 bolus in the pulmonary trunk. Cross clamp the ascending aorta and start cardioplegia and pneumoplegia solutions. During cardioplegia infusion, always control the ascending aorta pressure. At the end of pneumoplegia the retrieval operation starts.
KeywordsPulmonary Capillary Wedge Pressure Pulmonary Trunk Left Atrial Appendage Azygous Vein Left Pulmonary Vein
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