Donor lung procurement by surgical fellow with an expectation of high rate of lung utilisation

There is an ever increasing demand for donor lungs in patients waiting for transplantation. Lungs of many potential donors will be rejected if the standard criteria for donor assessment are followed. We have expanded our donor lung pool by accepting marginal donors and establishing a donation after circulatory death program. We have achieved comparable results using marginal donors and accepting donor lungs following donation after circulatory death. We present our assessment and technical guidelines on lung procurement taking into consideration an increasingly complex cohort of lung donors. These guidelines form the basis of the lung procurement training program involving surgical Fellows at the Alfred Hospital in Melbourne, Australia

Substantial Increases Occur in Serum Activins and Follistatin during Lung Transplantation

<p>SPSS file containing anonymised data set for the publication entitled: "Substantial Increases Occur in Serum Activins and Follistatin during Lung Transplantation".</p

Carbon dioxide insufflation in open-chamber cardiac surgery:a double-blind, randomized clinical trial of neurocognitive effects

ObjectiveThe aims of this study were first to analyze neurocognitive outcomes of patients after open-chamber cardiac surgery to determine whether carbon dioxide pericardial insufflation reduces incidence of neurocognitive decline (primary end point) as measured 6 weeks postoperatively and second to assess the utility of carbon dioxide insufflation in cardiac chamber deairing as assessed by transesophageal echocardiography.MethodsA multicenter, prospective, double-blind, randomized, controlled trial compared neurocognitive outcomes in patients undergoing open-chamber (left-sided) cardiac surgery who were assigned carbon dioxide insufflation or placebo (control group) in addition to standardized mechanical deairing maneuvers.ResultsOne hundred twenty-five patients underwent surgery and were randomly allocated. Neurocognitive testing showed no clinically significant differences in z scores between preoperative and postoperative testing. Linear regression was used to identify factors associated with neurocognitive decline. Factors most strongly associated with neurocognitive decline were hypercholesterolemia, aortic atheroma grade, and coronary artery disease. There was significantly more intracardiac gas noted on intraoperative transesophageal echocardiography in all cardiac chambers (left atrium, left ventricle, and aorta) at all measured times (after crossclamp removal, during weaning from cardiopulmonary bypass, and at declaration of adequate deairing by the anesthetist) in the control group than in the carbon dioxide group (P < .04). Deairing time was also significantly longer in the control group (12 minutes [interquartile range, 9–18] versus 9 minutes [interquartile range, 7–14 minutes]; P = .002).ConclusionsCarbon dioxide pericardial insufflation in open-chamber cardiac surgery does not affect postoperative neurocognitive decline. The most important factor is atheromatous vascular disease

Summary of patient and donor characteristics stratified by ischemic conditioning or sham treatment.

<p>Summary of patient and donor characteristics stratified by ischemic conditioning or sham treatment.</p

Correlations between activins and follistatin.

<p>Correlations between activins and follistatin.</p

The serum levels of the activin A.

<p>(A), activin B (B), follistatin (C), activin A to follistatin ratio (D), and activin B to follistatin ratio (E) measured over the 24 hour time course of this study are illustrated with the patients characterized according to a pathological classification based on the primary cause of their lung disorder.</p

Substantial Increases Occur in Serum Activins and Follistatin during Lung Transplantation - Fig 1

<p><b>(A)</b> Serum activin A levels for the patients are illustrated and compared to the upper and lower reference thresholds for normal healthy volunteers (25). <b>(B)</b> Serum activin B levels for the patients are illustrated and compared to the upper and lower reference thresholds for normal healthy volunteers (25). <b>(C)</b> Serum follistatin levels for the patients are illustrated and compared to the upper and lower reference thresholds for normal healthy volunteers (25). <b>(D)</b> Serum Activin A to follistatin ratios for the patients are compared with the upper and lower reference ratio thresholds for normal healthy volunteers (25). <b>(E)</b> Serum Activin B to follistatin ratios for the patients are compared with the upper and lower reference ratios for normal healthy volunteers (25).</p

Correlations between activin to follistatin ratios, and other cytokines, and between other cytokines.

<p>Correlations between activin to follistatin ratios, and other cytokines, and between other cytokines.</p