Techniques de protection du poumon et du bloc coeur-poumons en vue d'une transplantation

: Impaired healing of the bronchial anastomosis and its subsequent complications has been an important problem following lung transplantation. The decrease in the dosage of steroids, the use of cyclosporine immunosuppressive therapy and the use of an omental flap to revascularize rapidly the bronchial anastomosis, have reduced considerably the incidence of these post-operative bronchial complications. We have recently demonstrated that the application of a pedicled intercostal muscle graft or peritracheal membrane adipose tissue wrap on the bronchial anastomosis improved bronchial healing by restoring a vascular flow across the anastomosis within 7 days after left lung allotransplantation. Since the introduction of heart-lung transplantation at Stanford (USA) in 1981 and Pittsburgh in 1982 for the treatment of Eisenmenger's syndrome and terminal pulmonary vascular diseases, more than 250 combined heart-lung transplantations have been carried out throughout the world. However the present intermediate and long term results obtained with this operation have not yet reached the same level of success as cardiac transplantation alone. While several factors such as selection of candidates and donors have played a role in this difference, a prominent cause has been the lack of a reliable and simple method for pulmonary protection against prolonged ischemia. Most of the techniques proposed against ischemia can be classified as normothermic or static hypothermic cardiopulmonary preservation. The utilization of the normothermic method has not always been successful. For this reason, interest has now been directed towards the potential for hypothermic preservation of the heart-lung bloc and the use of free radical scavenger therapy in the reduction of reperfusion injury.