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Passive versus active right ventricular support during lung transplantation: Insights from a porcine pulmonary ischemia-reperfusion injury model
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DOI：10.1016/j.xjtc.2025.102193.png)
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Abstract
En 中文
Objectives: Bilateral lung transplantation might require venoarterial extracorporeal membrane oxygenation for intraoperative support. However, the impact of extracorporeal life support modalities on right ventricular function and pulmonary ischemia-reperfusion injury remains poorly understood. This study aimed to compare the effects of passive and active extracorporeal life support strategies on right ventricular performance, pulmonary injury, and systemic inflammation. Methods: By using a validated porcine surrogate bilateral lung transplantation model, animals were divided into 3 groups: no extracorporeal life support group (clamping, n = 9), passive extracorporeal circuit group without a mechanical pump but with a low-resistance oxygenator (pulmonary artery to left atrium bypass strategy, n = 7) between the pulmonary artery and left atrium, and a centrally cannulated venoarterial extracorporeal membrane oxygenation group (n = 7). Pulmonary injury, hemodynamic parameters, and inflammatory markers were comprehensively assessed. Results: Pulmonary edema was greater in extracorporeal membrane oxygenation versus a pulmonary artery to left atrium bypass strategy (wet-to-dry weight ratio, P = .0315). Right ventricular failure occurred in 5 of 9 animals in the clamping group but was absent in both pulmonary artery to left atrium bypass and extracorporeal membrane oxygenation groups. Extracorporeal membrane oxygenation led to significantly higher right ventricular afterload compared with clamping and pulmonary artery to left atrium bypass (arterial elastance, P = .0001 and P < .0001, respectively). Systemic inflammation appeared highest in extracorporeal membrane oxygenation, as reflected by interleukin-6 levels (clamping vs pulmonary artery to left atrium bypass strategy P = .0004; clamping vs extracorporeal membrane oxygenation P <.0001; pulmonary artery to left atrium bypass strategy vs extracorporeal membrane oxygenation P = .0004). Conclusions: Both pulmonary artery to left atrium bypass and extracorporeal membrane oxygenation prevented right ventricular failure in a setting of severe pulmonary ischemia-reperfusion injury. Our results suggest that pulmonary artery to left atrium bypass might provide better pulmonary protection and cause less inflammation than extracorporeal membrane oxygenation. These findings may guide further investigation of pumpless extracorporeal life support strategies for lung transplantation.
Keywords:
hemodynamics
lung transplantation
porcine model
right ventricle
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