Cardiopulmonary Bypass for Lung Transplantation in Cystic Fibrosis: Pilot Evaluation of Perioperative Outcome

Pochettino, Alberto; Augoustides, John G.T.; Kowalchuk, Deborah A.; Watcha, Sam M.; Cowie, Doreen; Jobes, David R.

doi:10.1053/j.jvca.2006.09.001

« Previous Next »Journal of Cardiothoracic and Vascular Anesthesia
Volume 21, Issue 2 , Pages 208-211, April 2007

Cardiopulmonary Bypass for Lung Transplantation in Cystic Fibrosis: Pilot Evaluation of Perioperative Outcome

Alberto Pochettino, MD
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
John G.T. Augoustides, MD, FASE
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
- Address reprint requests to John G.T. Augoustides, MD, FASE, Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 680 Dulles, 3400 Spruce Street, Philadelphia, PA 19104-4283.
Deborah A. Kowalchuk, BA
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
Sam M. Watcha, BA
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
Doreen Cowie, CCP
- Department of Clinical Perfusion, Hospital of the University of Pennsylvania, Philadelphia, PA.
David R. Jobes, MD
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA

published online 12 December 2006.

Objective: The purpose of this study was to determine whether cardiopulmonary bypass (CPB) reduces the incidence of perioperative graft infection after lung transplantation in adults with cystic fibrosis (CF).

Design: Retrospective and observational.

Setting: University hospital.

Participants: Adults with CF who underwent lung transplantation (1998-2003).

Interventions: None.

Measurements and Main Results: Cohort size was 26: group A (n = 10) who underwent CPB for implantation of both lungs, group B (n = 8) who underwent CPB only for implantation of the second lung, and group C (n = 8) who did not undergo CPB. The 3 cohort subgroups were similar (p > 0.05) in demographics, preoperative lung function, and anesthetic management. Group A had a lower incidence of perioperative pneumonia (p = 0.02). CPB exposure increased transfusion (B > A > C) of fresh frozen plasma and platelets but not packed red blood cells. There were no differences (p > 0.05) in clinical outcome as reflected by duration of mechanical ventilation, tracheal re-intubation, re-exploration for bleeding, sepsis, primary graft dysfunction, renal dysfunction, length of stay, and mortality.

Conclusions: CPB is associated with decreased incidence of early graft infection after lung transplantation for adult CF when used for implantation of both lungs. This may be because of improved decontamination of the operative field before graft implantation.

Key words: cystic fibrosis, lung transplantation, cardiopulmonary bypass, infection, adults