Bronchial Arterial Perfusion

Inadequate perfusion of the bronchial vascular bed during standard antegrade pulmonary artery flush might be a possible mechanism of inadequate pulmonary preservation. Perfusion of the isolated descending thoracic aorta allows delivery of preservative solution through the bronchial arteries, in addition to the usual mechanism of direct pulmonary artery perfusate delivery. A canine study demonstrated superiority in terms of intrapulmonary shunt fraction, improved static compliance, intrapulmonary leukosequestration, and elastic work when lungs were preserved with dual circulation extracellular-type preservative perfusion than with either isolated bronchial or pulmonary arterial perfusion.21 This dual blood supply was exploited by some transplant centers by revascularizing the segment of thoracic aorta, which contains the bronchial arteries with internal thoracic artery or saphenous vein grafts, thereby preserving the dual circulation and theoretically improving bronchial anastomotic outcomes (in terms of healing and stenosis).

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