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Background: The experience at Loyola University Chicago was retrospectively reviewed to evaluate survival and functional outcome after single lung transplantation (SLT) and bilateral lung transplantation (BLT)., Methods: Ninety patients underwent lung transplantation at Loyola University Chicago between April 1990 and December 1993. Mean age was 45 years (range, 13 to 66 years). Fifty percent were male. Pre-lung transplant pulmonary diseases were as follows: emphysema and/or chronic obstructive pulmonary disease in 43 patients, pulmonary fibrosis in 13, cystic fibrosis in 14, pulmonary hypertension in eight, repeated transplantation for obliterative bronchiolitis in four, bronchiectasis in two, bronchoalveolar cell carcinoma in two, sarcoidosis in one, primary obliterative bronchiolitis in one, histiocytosis X in one, and lymphangiomyomatosis in one. Fifty-seven patients underwent SLT, and 33 had BLT. Maintenance immunosuppression medications consisted of cyclosporine, azathioprine, and prednisone., Results: Perioperative complications were as follows: seven of 33 patients bled after BLT, and two of 57 bled after SLT. Bronchial complications were found in six of 66 (9%) BLT anastomoses and eight of 57 (14%) SLT anastomoses. Nine operative deaths occurred in SLT patients: six from allograft failure, one from infection, one from intrapulmonary hemorrhage, and one from bronchial dehiscence. Only two patients died in the perioperative period after BLT and that was of infection. Three late deaths occurred after BLT, all as a result of infection; 13 recipients died late after SLT: five of infection, four patients from lymphoma, two of pancreatitis, one of tension pneumothorax, and one of pulmonary embolism. For the entire patient population the actuarial 1- and 2-year survival rates were 72% and 68%, respectively. One-year survival rates were significantly better for patients undergoing lung transplantation for obstructive and nonrestrictive lung diseases than those of patients undergoing lung transplantation for vascular or restrictive pulmonary disease. Recipients of BLT had a trend toward better survival than recipients of SLT. Lung function 6 months after transplantation measured by forced expiratory volume in 1 second was significantly better in BLT than SLT, 71% of predicted versus 54%., Conclusions: Patients who undergo BLT have significantly better postoperative pulmonary function than those who undergo SLT. On the basis of the study there was a trend toward better survival with BLT.

The proliferation of transplantation programs has not been paralleled by a similar increase in the availability of organ donors. Between 1984 and 1987, 104 orthotopic heart transplantations were performed at Loyola University Medical Center. During the same period, 25 patients died while awaiting a donor organ. To reduce the mortality, we began using the total artificial heart (TAH) and a ventricular assist device (VAD) as a bridge to transplantation in 1988. Of 29 patients who underwent transplantation, 15 patients required a TAH and three patients required a VAD as a bridge. The underlying heart conditions were ischemic cardiomyopathy (11 patients), dilated cardiomyopathy (5 patients), giant cell myocarditis (1 patient), and allograft failure (1 patient). The average duration of mechanical support was 10 days (range, 1 to 35 days). Of the 17 patients who successfully underwent transplantation, 1 patient died at 17 days because of acute rejection of the transplanted heart, and another patient died at 14 days because of a cerebral vascular event. Fifteen patients (83%) were long-term survivors. Nine patients required reoperation for bleeding. While the mechanical device was in place, the activated clotting time was maintained between 170 and 200 seconds with heparin. Dipyridamole was given. We conclude that the TAH and VAD are excellent mechanical bridges to transplantation.

This study reviews the cases of 15 patients with severe cardiac disease treated with the intra-aortic balloon pump (IABP) to improve cardiac status so that they could undergo definitive cholecystectomy. The 14 men and one woman ranged in age from 49 to 74 years. Indications for cholecystectomy included acute cholecystitis in nine patients and chronic cholecystitis in six patients. All patients had prior myocardial infarction, and in two patients this had occurred within 2 months of operation. All patients were Goldman's Class IV. Eight had severe cardiomyopathy. Mean ventricular ejection fraction was 21% +/- 3%. Cardiac index was 2.2 +/- 0.2 L/m/m2, and pulmonary artery pressure (PAP) was 51 +/- 5/23 +/- 2 mm Hg. After IABP placement, pulmonary wedge pressure decreased in all patients, from 24 +/- 3 mm Hg to 16 +/- 2 mm Hg (p less than 0.01). PAP systolic pressure decreased to 38 +/- 3 mm Hg (p less than 0.01), and PAP diastolic pressure decreased to 18 +/- 2 mm Hg (p less than 0.05). All patients had cholecystectomy. Five patients had intraoperative cholangiography. One of these five patients had a common bile duct exploration, and another underwent cystgastrostomy. Two patients died postoperatively of arrhythmias. Thirteen patients are alive 3 months to 7 years after operation, without biliary symptoms. Three patients have had orthotopic heart transplants. We conclude that IABP significantly improves cardiac performance so that many patients who have severe cardiac disease can undergo definitive biliary surgery.

Hypothermic cardioplegia (HCP) is a method commonly used for myocardial preservation at the time of aortic cross-clamping during coronary artery bypass grafting (CABG). This study assessed the frequency and significance of transient bundle branch block (BBB) in 50 patients undergoing CABG using HCP compared to 61 controls. All patients had normal QRS complexes on preoperative ECG. CLinical, hemodynamic, and operative data were similar in both groups. Seventeen (34%) of the HCP group and four (6%) of the controls developed postoperative BBB (p less than 0.001). These changes were transient in all but three patients in the HCP group. None of the HCP patients with transient BBB had evidence of perioperative myocardial infarction. Clinical and operative parameters did not provide prediction of development of transient BBB. This study demonstrates that transient BBB in the immediate post-CABG period occurs commonly with the use of HCP and does not indicate myocardial necrosis.