Technical Pearls for Swine Lung Transplantation

Karimi, Ashkan; Cobb, Jessica A.; Staples, Edward D.; Baz, Maher A.; Beaver, Thomas M.

doi:10.1016/j.jss.2011.05.067

Cited by 21 publications

(13 citation statements)

References 11 publications

(40 reference statements)

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“…in pigs and in sheep, the left vena azygos drains directly into the coronary sinus. 34,35 None of the studies mentioned a ligation of the left vena azygos; however, it remains open to which extent this fact compromises the hemodynamic condition or the measurement of important cardiovascular parameters such as the CO or coronary venous flow.…”

Section: Surgical Creation Of An Extracardiac Tcpcmentioning

confidence: 99%

Approaches to Establish Extracardiac Total Cavopulmonary Connections in Animal Models—A Review

Granegger

Valencia

Quandt

et al. 2019

World J Pediatr Congenit Heart Surg

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BACKGROUND Long-term survival of patients with a single ventricle palliated with a Fontan procedure is still limited. No curative treatment options are available. To investigate the pathophysiology and potential treatment options, such as mechanical circulatory support (MCS), appropriate large animal models are required. The aim of this review was to analyze all full-text manuscripts presenting approaches for an extracardiac total cavopulmonary connection (TCPC) animal model to identify the feasibility and limitations in the acute and chronic setting. METHODS A literature search was performed for fulltext publications presenting large animal models with extracardiac TCPCs on Pubmed and Embase. Out of 454 reviewed papers, 23 manuscripts fulfilled the inclusion criteria. Surgical procedures were categorized and hemodynamic changes at the transition from the biventricular to the univentricular condition analyzed. RESULTS Surgical procedures varied especially regarding coronary venous flow handling and anatomic shape of the TCPC. In most studies (n = 14), the main pulmonary artery was clamped and the coronary venous flow redirected by additional surgical interventions. Only in five reports, the caval veins were connected to the right pulmonary artery to create a true TCPC shape, whereas in all others (n = 18), the veins were connected to the main pulmonary artery. An elevated pulmonary vascular resistance was identified as a limiting hemodynamic factor for TCPC completion in healthy animals. CONCLUSIONS A variety of acute TCPC animal models were successfully established with and without MCS, reflecting the most important hemodynamic features of a Fontan circulation; however, chronic animal models were not reported.

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Section: Surgical Creation Of An Extracardiac Tcpcmentioning

confidence: 99%

Approaches to Establish Extracardiac Total Cavopulmonary Connections in Animal Models—A Review

Granegger

Valencia

Quandt

et al. 2019

World J Pediatr Congenit Heart Surg

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“…Given the presence of an additional tracheal bronchus on the right side, left pneumonectomy has been preferred over right pneumonectomy due to simpler anatomy 8 . Most studies that utilize unilateral pneumonectomy do not describe the procedure and care in detail.…”

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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“…Many researchers have developed models of one-lung transplantation in large animals. [8][9][10][11]16] These models transplant a single allograft lung into a recipient animal. In some of these models, the contralateral lung is left untouched and unmodi ed and is still being fully perfused and ventilated.…”

Section: Discussionmentioning

confidence: 99%

A Novel Experimental Porcine Model to Assess the Impact of Differential Pulmonary Blood Flow on Ischemia-reperfusion Injury After Unilateral Lung Transplantation

Frick

Orlitová

Vanstapel

et al. 2021

Preprint

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Background Primary graft dysfunction (PGD) remains a major obstacle after lung transplantation. Ischemia-reperfusion injury is a known contributor to the development of PGD following lung transplantation. We developed a novel approach to assess the impact of increased pulmonary blood flow in a large porcine single-left lung transplantation model.Materials Twelve porcine left lung transplants were divided in two groups (n = 6, in low (LF) and high flow (HF) group). Donor lungs were stored for 24 hours on ice, followed by left lung transplantation. In the HF group, recipient animals were observed for 6h after reperfusion with partially clamping right pulmonary artery to achieve a higher flow (target flow 40 – 60% of total cardiac output) to the transplanted lung compared to the LF group, where the right pulmonary artery was not clamped.Results Survival at 6 hours was 100% in both groups. Histological, functional and biological assessment did not significantly differ between both groups during the first 6 hours of reperfusion. injury was also present in the right native lung and showed signs compatible with the pathophysiological hallmarks of ischemia-reperfusion injury.Conclusions Partial Clamping native pulmonary artery in large animal lung transplantation setting to study the impact of low versus high pulmonary flow on the development of ischemia reperfusion is feasible. In our study, differential blood flow had no effect on IRI. However, our findings might impact future studies with extra-corporeal devices and represents a specific intra-operative problem during bilateral sequential single lung transplantation.

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Technical Pearls for Swine Lung Transplantation

Cited by 21 publications

References 11 publications

Approaches to Establish Extracardiac Total Cavopulmonary Connections in Animal Models—A Review

Approaches to Establish Extracardiac Total Cavopulmonary Connections in Animal Models—A Review

Technique and perioperative management of left pneumonectomy in neonatal piglets

A Novel Experimental Porcine Model to Assess the Impact of Differential Pulmonary Blood Flow on Ischemia-reperfusion Injury After Unilateral Lung Transplantation

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