Thorac Cardiovasc Surg 2007; 55 - P_127
DOI: 10.1055/s-2007-967682

Exogenic surfactant therapy as an adjunct for lung preservation – evaluation of the optimal time point for instillation

T Wittwer 1, R Nagib 2, M Ochs 3, M Vollroth 2, C Mühlfeld 3, M Navid 1, J Groetzner 1, D Vehre 2, T Wahlers 1
  • 1Universität zu Köln, Herzzentrum, Klinik für Herz- und Thoraxchirurgie, Köln, Germany
  • 2Friedrich-Schiller Universität Jena, Klinik für Herz- und Thoraxchirurgie, Jena, Germany
  • 3Universität Bern, Institut für Experimentelle Morphologie, Bern, Switzerland

Aims: Optimal preservation of organ function is crucial in clinical lung transplantation as ischemia/reperfusion-injury (IRI) results in pathophysiologically important alterations of endogenous surfactant integrity. Application of exogenic surfactant was shown to be effective in prevention and therapy of IRI. However systematic experimental studies on optimal timing of modern natural porcine surfactant application containing both important surfactant proteins SP-B and SP-C (Curosurf©) are pending.

Methods: In an extracorporeal rat model, lungs (n=5/group) were preserved using Perfadex preservation and stored for 4-hrs. In the 3 test groups, Curosurf was administered at different time points: prior to flush preservation (T1), following cold ischemia (T2), and during reperfusion (T3). Results were compared with a control (nS) without surfactant instillation. Postischemic lungs were re-ventilated and reperfused with xenogeneic blood using an extracorporeal circuit. Oxygenation (paO2), pulmonary hemodynamics (PAP) and inspiratory pressures (PIP) were monitored continuously. Intraalveolar edema was quantified stereologically. Statistics comprised ANOVA with repeated measurements.

Results: Oxygenation of T1 lungs was superior as compared to all other groups T2, T3 and nS (p<0.02), while both PAP- and PIP-values were comparable between all Curosurf-treated groups. Stereology supported the oxygenation data with a clear tendency towards less intrapulmonary oedema in group T1.

Conclusions: Allograft pretreatment with endobronchial Curosurf©-instillation prior to preservation provides optimised preservation quality as compared to delayed application following ischemia or during reperfusion and results in improved functional outcome. Additional experiments including ultrastructural surfactant analysis will evaluate IRI-specific synthetically produced „designer“-surfactant with recombinant surfactant proteins to further optimise modern lung preservation.