Preliminary study of extracorporeal circulation management in heart-lung transplantation

Li Guanjun; Ding Li; Dong Nianguo; Li Ping

doi:10.13498/j.cnki.chin.j.ecc.2024.02.09

Abstract：Objective To summarize the preliminary experience of cardiopulmonary bypass management in heart-lung transplantation.Methods The cases with orthotopic heart-lung transplantation from July 2014 to December 2022 were analyzed.They were 4 male patients and 1 female patient,aged 22 to 37 years with a weight of 46 to 60 kg.They were diagnosed with severe pulmonary hypertension combined with cardiopulmonary failure,and three of them were Eisenmenger syndrome.Results Donor cardiopulmonary cold ischemia time was 225 to 420 min.The cardiopulmonary time was 188 to 323 min,the aortic blocking time was 108 to 219 min,and cardiopulmonary bypass assistance time was 71 to 134 min,the extracorporeal flow was 2.4-3.2 L/(m2∙min),and the mean arterial pressure was 50-80 mmHg.Modified ultrafiltration was used during the operation,and the dosage of ultrafiltrate was 1500-2000 ml.Four patients were successfully evacuated from cardiopulmonary bypass,one patient experienced difficulty in postoperative hemostasis and circulatory instability with poor conventional drug treatment,and he was treated with extracorporeal membrane oxygenation(ECMO),intra-aortic balloon pump(IABP)and continuous renal replacement therapy.ECMO was successfully evacuated after 153 hours.All five patients were finally left alive and discharged.Conclusion The cardiopulmonary bypass management of heart-lung transplantation has a certain particularity.Once postoperative respiratory and circulatory failure is refractory to conventional drug treatment,mechanical circulatory adjuvant combination therapy,such as IABP or ECMO,should be actively used as early as possible.