[Heart-lung preservation: historical evolution and current research data]

Over the past decade, combined, heart-lung transplantation has been established as a therapeutic modality for many patients with end stage cardiopulmonary disease. However, the scarcity of suitable donors and the lack of a reliable and simple technique for distant organ procurement have somewhat limited its practice. The normothermic autoperfusion preparation has been utilized in a few satisfactory distant heart-lung preservation and subsequent transplantation, but this method is rather cumbersome. Single cold flush perfusion of the pulmonary artery with infusion of prostaglandin E1, a powerful vasodilator of the pulmonary bed, has been used successfully in heart-lung preservation for transplantation. Donor core-cooling through cardiopulmonary bypass without pulmonary artery flush perfusion appears to provide longer and better graft protection since it improves its function. The production of oxygen radicals after reperfusion of ischemic tissues has important implications in organ preservation and transplantation. Recent studies in the prevention of reperfusion injury indicate that enzymatic scavenger and iron chelator therapy may play an important role in the reduction of reperfusion injury in the clinical setting of heart-lung transplantation.