Experimental left pneumonectomy in pigs: procedure and management

Bufalari, Antonello; Monte, Valentina De; Pecoriello, Roberta; Donati, Livia; Ceccarelli, Silvia; Cagini, Lucio; Ragusa, Mark; Vannucci, Jacopo

doi:10.1016/j.jss.2015.05.045

Cited by 12 publications

(13 citation statements)

References 22 publications

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“…al. published the first report that comprehensively described the technique in adult swine 9 . Pneumonectomy performed in piglets requires significant modifications to the surgical approach due to their smaller size and limited physiologic reserve.…”

Section: Introductionmentioning

confidence: 99%

Technique and perioperative management of left pneumonectomy in neonatal piglets

Dao

Anez‐Bustillos

O’Loughlin

et al. 2017

Journal of Surgical Research

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Background Although commonly performed in adult swine, unilateral pneumonectomy in piglets requires significant modifications in the surgical approach and peri-operative care due to their smaller size and limited physiologic reserve. Methods Nineteen neonatal piglets underwent a left pneumonectomy. They were allowed 5–7 days of pre-operative acclimation and nutritional optimization. Pre-operative weight gain and laboratory values were obtained before the time of surgery. A “ventro-cranial” approach is adopted where components of the pulmonary hilum were sequentially identified and ligated, starting from the most ventral and cranial structure, the superior pulmonary vein. The principle of gentle ventilation was followed throughout the entire operation. Results The median age of the piglets at the time of surgery was 12 (10–12) days. The median pre-operative weight gain and albumin level were 20 (16–16)% and 2.3 (2.1–2.4) g/dL, respectively. The operation required a median of 59 (50–70) minutes to complete. Five of the first 9 piglets died from complications, two from poor pre-operative nutritional optimization (both with less than 10% weight gain and 2 g/dL for albumin), one from an intubation complication, one from intra-operative bleeding, and one in the post-operative period from a ruptured bulla. No mortality occurred for the next 10 cases. Conclusions Successful outcomes for unilateral pneumonectomy in piglets require special attention to pre-operative nutritional optimization, gentle ventilation, and meticulous surgical dissection. Pre-operative weight gain and albumin levels should be used to identify appropriate surgical candidates. The “ventro-cranial” approach allows for a technically straightforward completion of the procedure.

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Section: Introductionmentioning

confidence: 99%

Technique and perioperative management of left pneumonectomy in neonatal piglets

Dao

Anez‐Bustillos

O’Loughlin

et al. 2017

Journal of Surgical Research

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“…Experimental pneumonectomy has been performed in pigs [5], and the short-term outcome of thoracoscopic lung lobectomy for primary lung tumors has been performed in dogs [6]. Several studies on VATS procedures in animals have evaluated stress parameters and postoperative outcomes [7, 8]; there have also been studies into the outcomes of VATS lobectomy [9].…”

Section: Introductionmentioning

confidence: 99%

Comparison of acute phase reaction and postoperative stress in pigs undergoing video-assisted thoracoscopic versus thoracotomy pneumonectomy

et al. 2016

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BackgroundVideo-assisted thoracoscopic surgery (VATS) has been used for many thoracic diseases as an alternate approach to thoracotomy. The aim of this study was to compare the surgical outcome of pneumonectomy using VATS with that using thoracotomy pneumonectomy in pigs. Fourteen pigs were equally divided into two groups; one group underwent VATS and the other group underwent transthoracic pneumonectomy. We monitored pre-, intra-, and post-operative physiologic parameters, along with blood cell count, serum C-reactive protein (CRP), serum amyloid A (SAA), interleukin-6 (IL-6) and cortisol. The differences between the two approaches were analyzed.ResultsMean surgical time in the VATS group (160.6 ± 16.2 min) was significantly longer than that in the thoracotomy group (123.7 ± 13.2 min). In both groups, CRP and IL-6 concentrations were significantly increased at postoperative 4 h, and then gradually decreased to preoperative levels. CRP and IL-6 at postoperative day 1 were significant lower in the VATS group compared with the thoracotomy group. SAA was significantly increased at postoperative days 1 and 3 in both groups compared with preoperative levels. Cortisol was significantly increased immediately after surgery in both groups compared with preoperative levels, and was significantly higher in the thoracotomy group than the VATS group at postoperative 4 h and 1 day.ConclusionsThere was no difference between the two groups in physiologic parameters and blood cell count. However, the results indicate that VATS resulted in a smaller incision, less acute-phase reaction, less stress and less pain compared with thoracotomy pneumonectomy.

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“…The quantity of Collagen I, III and IV are all signi cantly reduced in human aneurysms compared to non-aneurysmal acute ruptured porcine samples. Reassuringly there is good reproducibility of quanti cation between porcine and human non-aneurysmal samples as shown in earlier studies (4)(5)(6)(7)(8)(9)(10)(11)(12)(13) Limitations in this study includes histological analysis, whereby immunohistochemistry techniques are limited by the ability of the tissue to take up by the antibodies in question which result in more di cult specimens to analyse and quantify. In addition, pathological analysis and quanti cation are limited by the investigator and varies considerably with each analysis.…”

Section: Discussionmentioning

confidence: 82%

“…Using a physiological model, results could identify patterns in radiological, pathological, and histological changes that affect the aorta under stress. Although no studies apart from Surman et al (1) have reported on the maximal pressures obtained in the porcine aortic root and ascending aorta, many studies have showed that a porcine model is effective in the application of cardiopulmonary bypass and replicating models applicable to human subjects in cardiothoracic surgery (4)(5)(6)(7)(8)(9)(10)(11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

The susceptibility of the aortic root: porcine aortic rupture testing under cardiopulmonary bypass

Surman

Abrahams

Manavis

et al. 2021

Preprint

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Background In our earlier study on the functional limits of the aneurysmal aortic root we determined the pig root is susceptible to failure at high aortic pressures levels. We established a pig rupture model using cardiopulmonary bypass to determine the most susceptible region of the aortic root under the highest pressures achievable using continuous flow, and what changes occur in these regions on a macroscopic and histological level. This information may help guide clinical management of aortic root and ascending aorta pathology. Methods Five pigs underwent 4D flow MRI imaging pre surgery to determine vasopressor induced wall sheer stress and flow parameters. All pigs were then placed on cardiopulmonary bypass (CPB) via median sternotomy, and maximal aortic root and ascending aorta flows were initiated until rupture or failure, to determine the most susceptible region of the aorta. The heart was explanted and analysed histologically to determine if histological changes mirror the macroscopic observations. Results The magnetic resonance imaging (MRI) aortic flow and wall sheer stress (WSS) increased significantly in all regions of the aorta, and the median maximal pressures obtained during cardiopulmonary bypass was 497mmHg and median maximal flows was 3.96L/m. The area of failure in all experiments was the non-coronary cusp of the aortic valve. Collagen and elastin composition (%) was greatest in the proximal regions of the aorta. Collagen I and III showed greatest content in the inner aortic root and ascending aorta regions. Conclusions This unique porcine model shows that the aortic root is most susceptible to failure at high continuous aortic pressures, supported histologically by different changes in collagen content and subtypes in the aortic root. With further analysis, this information could guide management of the aortic root in disease.

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Experimental left pneumonectomy in pigs: procedure and management

Abstract: After the delineation of this methodology, the compliance to a routine practice allowed us to reduce time, stress, and cost; quality and quantity of possible research increased.

Cited by 12 publications

References 22 publications

Technique and perioperative management of left pneumonectomy in neonatal piglets

Technique and perioperative management of left pneumonectomy in neonatal piglets

Comparison of acute phase reaction and postoperative stress in pigs undergoing video-assisted thoracoscopic versus thoracotomy pneumonectomy

The susceptibility of the aortic root: porcine aortic rupture testing under cardiopulmonary bypass

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