Successful bronchial revascularization in experimental single lung transplantation

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Abstract
It is the purpose of this paper to report our experience with bronchialartery revascularization in an experimental model of single lungtransplantation in swine. Thirty-three large white pigs weighing 20-40 kgunderwent left lung allotransplantation. In 24 animals, bronchial arteryrevascularization was attempted by anastomizing the aortic patch containingthe bronchial artery orifice with the recipient descending aorta. Eightsurvivors were put to death on postoperative days 11-15; five animals wereput to death or died on postoperative days 2-9; the other animals diedintra-operatively or within a few hours. Preservation of left bronchialvascularization was achieved in all cases attempted, as documented bypost-mortem injection of dye (methylene blue) or contrast medium. Five ofthe 8 animals surviving for 11-15 days showed diffuse graft hepatization,associated with diffuse vascular thrombosis. Whether this was caused bydamage to the endothelium due to poor graft preservation or by rejectionwas unclear. In animals surviving for 11-15 days without gross lungpathology, the anastomosis and bronchial mucosa were completely normal; incontrast, bronchial ischaemic changes were found in nonrevascularizedanimals and in survivors with graft hepatization. Our experience confirmsthat re- anastomosis of the bronchial arteries can prevent bronchialhealing problems in single lung transplantation. The pig is an ideal modelfor these experiments since the bronchial arteries have a constant commonaortic origin, allowing easy identification and preservation of leftbronchial vascularization.

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