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Broncho-/tracheoplastische Ex-situ-Operationen im „organ care system“

Ex situ tracheobronchoplastic operations using the organ care system

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Zusammenfassung

Die klinischen Erfahrungen im Rahmen der Lungentransplantation zeigen, dass das OCS („organ care system“) eine Perfusion und Ventilation der Lungen unter nahezu physiologischen Bedingungen ermöglicht. Die Thoraxchirurgie kennt Situationen, in denen erst eine Ex-situ-Operation eine Resektabilität ermöglicht. Ziel dieser Arbeit ist es, zu zeigen, dass es technisch möglich ist, Ex-situ-Operationen im OCS durchzuführen.

Die Deckung eines tracheobronchialen Defektes durch einen Perikard-Patch wurde unter tierexperimentellen Bedingungen durchgeführt. Ein entsprechendes Votum der Tierschutzkomission liegt vor. Die zweite Operation (Ersatz der distalen Trachea durch ein Aortensegment) wurde an einem Doppellungenpräparat eines Hausschweins vom Schlachthof vorgenommen.

Die Lungen ließen sich postoperativ problemlos belüften. Der mittlere pulmonal-arterielle Druck konnte perioperativ konstant gehalten werden. Die Maßnahmen zur Lungenödemprophylaxe waren effektiv.

Technisch sind Operationen im OCS möglich. Vor einer klinischen Anwendung müssen technische Optimierungen am OCS selbst vorgenommen werden und weitere Erfahrungen im Umgang mit der Lunge in der Ex-situ-Situation gesammelt werden.

Abstract

First clinical experiences with the organ care system (OCS) in lung transplantation showed that this device allows perfusion and ventilation of the lungs under practically physiological conditions. Some pulmonary pathologies necessitate ex situ operations, e.g. to avoid pneumonectomy. The objective of this work was to investigate the feasibility of ex situ pulmonary surgery within the OCS.

In the first procedure a large tracheobronchial leakage was covered with a pericardial patch. The procedure was authorized by the local committee of animal welfare. In the second surgery a replacement of the distal trachea using an aortic graft was performed after removal of the heart-lung segment from a pig from the slaughterhouse. The postoperative ventilation of both lungs was free of problems. The mean pressure of the pulmonary artery remained steady during the whole experiment. The setup to prevent lung edema was basically successful.

Performing thoracic surgery with the OCS is feasible; however, this approach is reserved for very special indications. Further investigations to optimize technical details of the OCS setup for this purpose are necessary.

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Authors and Affiliations

  1. Klinik für Herz-, Transplantations-, Thorax- und Gefäßchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    M. Krüger, N. Zinne, H. Höffler, R. Zhang, I. Kropivnitskaja, J. Schmitto, A. Ciubotaru & A. Haverich

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  1. M. Krüger
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  2. N. Zinne
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  3. H. Höffler
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  4. R. Zhang
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  5. I. Kropivnitskaja
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  6. J. Schmitto
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  7. A. Ciubotaru
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  8. A. Haverich
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Correspondence to M. Krüger.

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Krüger, M., Zinne, N., Höffler, H. et al. Broncho-/tracheoplastische Ex-situ-Operationen im „organ care system“. Chirurg 84, 208–213 (2013). https://doi.org/10.1007/s00104-012-2444-1

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  • DOI: https://doi.org/10.1007/s00104-012-2444-1

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