Long-term survival of dogs after experimental pulmonary reimplantation and staged contralateral pneumonectomy

Abstract

Sixteen dogs which survived left pulmonary reimplantation were subjected to staged contralateral pneumonectomy. Complete excision of the right lung was achieved in nine of these animals. There were three long-term survivors, of which two lived for more than three years on the singl$e reimplanted lung. Stenosis of the pulmonary veins at the level of the atrial anastomosis was the commonest post-mortem finding. In the first week after reimplantation, the ventilation and oxygen uptake of the reimplanted lung invariably fell to low levels. These usually rose slowly but to a variable extent over the next six to eight weeks, after which there was little further improvement while the normal lung remained intact. In all three long-term survivors the ventilation and oxygen uptake of the reimplanted lung were more than doubled after contralateral pneumonectomy; the rise in oxygen uptake was less and occurred later than the rise in ventilation. Pulmonary hypertension and pulmonary oedema did not occur except in association with organic obstruction to the pulmonary venous drainage.Survival of experimental animals on a single reimplanted lung is uncommon. The initial operation of pulmonary reimplantation carries a high mortality rate (Blumenstock and Kahn, 1961;Linberg, Demetriades, Armstrong, and Konsuwan, 1961;Yeh, Ellison, and Ellison, 1962;Alican and Hardy, 1963; Nigro, Evans, Benfield, Gaco, Fry, and Adams, 1963;Haglin, Telander, Muzzall, Kiser, and Strobel, 1963;Shaw and Burton, 1964;Borrie and Lichter, 1964;Davies, Rosser, and West, 1965;Guilmet, Brunet, Krakora, Leiva, and Weiss, 1965) Nigro and his colleagues (1961, 1963) were the first to suggest that staged ablation of the opposite lung might increase the chances of an animal surviving on a single reimplanted lung. They reported long-term survival in 5 of 16 dogs successively subjected to right lung reimplantation, left upper lobectomy, and cauterization of the left lower lobe bronchus with silver nitrate. The technique effectively confines gaseous exchanges to the reimplant but it leaves the nerve supply (and possibly the vasculature) of the left lower lobe intact. A staged but complete excision of the opposite lung, therefore, is a more rigorous test of the function of the pulmonary autograft. By resecting the right lung in two or three operations after left pulmonary reimplantation we have achieved long-term survival in 3 of 16 dogs. MATERIAL AND METHODSMongrel dogs of about 20 kg. weight had the left lung reimplanted by a standard method (Neptune, Redondo, and Bailey, 1953;Neptune, Weller, and Bailey, 1953). Sixteen survivors were submitted to staged excision of the right lung, begun at various times between 12 days and 8 months after reimplantation. Dogs which survived the first stage had a second -and sometimes a third-operation at intervals of two to four weeks to complete the right pneumonectomy. The choice and number of lobes removed at each operation depended on the state of the reimplant's function as determined beforehand by bronchospirometry.Period...

Pulmonary mechanics and surfactant measurement in canine lungs following reimplantation

“…Prolonged survival of animals with a single reimplanted lung after contralateral pneumonectomy (Hill and Shaw, 1968) and with bilaterally reimplanted lungs (Fafber, Pedreira, Pevsner, and Beattie, 1965) demonstrates that considerable pulmonary function may be regained. However, it is clear from these and other studies that there is impairment of function, especially in the postoperative period, after which improvement may occur.…”