Improved Pulmonary Venous Anastomosis Using a Single Left Atrial Cuff in One-Stage Bilateral Lung Autotransplantation

A technical modification in pulmonary venous anastomosis is presented for one-stage bilateral lung autotransplantation in dogs. This method nullified or minimized both narrowing and loss of vascular distensibility due to scar formation at anastomotic line which inevitably resulted in functional defects after the operation. In this new procedure, bilateral pulmonary arteries were anastomosed using angioplastic techniques and both right and left pulmonary veins were sutured orthotopically as a single atrial cuff. Of 11 dogs which underwent one-stage bilateral lung replantation, 6 survived after operation. Sites of vascular anastomoses in the long-term survivors showed no narrowing due to scar formation at autopsy after hemodynamic examination. In these animals rapid and continuing infusion of 2000 to 3000 ml of blood or plasma explander was performed within 15 min through an intraatrial catheter. Various hemodynamic values were measured simultaneously. In the dog with bilateral lung transplants pulmonary arterial pressure showed linear increase with an increase in cardiac output when compared with control animal studies. It could be interpreted from these results that some changes occurred in the mechanism of pulmonary circulation of the transplant.