Retrograde lung perfusion in the treatment of massive pulmonary embolism. A randomised porcine study

Kjærgaard, Benedict; Honge, Jesper L.; Magnúsdóttir, Sigríður Olga; Rasmussen, Bodil Steen; Baandrup, Ulrik; Hasenkam, J. Michael; Kristensen, Søren Risom

doi:10.1016/j.thromres.2014.12.003

Cited by 4 publications

(7 citation statements)

References 11 publications

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“…In contrast to the more common flow reversal in systemic vessels, there are only a few circumstances for retrograde perfusion in the pulmonary circulation. Flow reversal in the pulmonary circulation has only been reported in case reports of operative thrombectomy due to pulmonary embolisms [ 27 ]. The transfer to the (patho-)physiological conditions of retrograde pulmonary flow in the human body is very limited, since even rare cases, like mitral valve insufficiency, which can be accompanied by a retrograde flow in the pulmonary veins, still differ regarding flow velocity, pressure and disturbances.…”

Section: Discussionmentioning

confidence: 99%

Never Change a Flowing System? The Effects of Retrograde Flow on Isolated Perfused Lungs and Vessels

Krabbe

Klassen

Bleidorn

et al. 2021

Cells

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Retrograde perfusion may occur during disease, surgery or extracorporeal circulation. While it is clear that endothelial cells sense and respond to changes in blood flow, the consequences of retrograde perfusion are only poorly defined. Similar to shear stress or disturbed flow, retrograde perfusion might result in vasomotor responses, edema formation or inflammation in and around vessels. In this study we investigated in rats the effects of retrograde perfusion in isolated systemic vessels (IPV) and in pulmonary vessels of isolated perfused lungs (IPL). Anterograde and retrograde perfusion was performed for 480 min in IPV and for 180 min in the IPL. Perfusion pressure, cytokine levels in perfusate and bronchoalveolar lavage fluid (BALF), edema formation and mRNA expression were studied. In IPV, an increased perfusion pressure and initially also increased cytokine levels were observed during retrograde perfusion. In the IPL, increased edema formation occurred, while cytokine levels were not increased, though dilution of cytokines in BALF due to pulmonary edema cannot be excluded. In conclusion, effects of flow reversal were visible immediately after initiation of retrograde perfusion. Pulmonary edema formation was the only effect of the 3 h retrograde perfusion. Therefore, further research should focus on identification of possible long-term complications of flow reversal.

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Section: Discussionmentioning

confidence: 99%

Never Change a Flowing System? The Effects of Retrograde Flow on Isolated Perfused Lungs and Vessels

Krabbe

Klassen

Bleidorn

et al. 2021

Cells

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“…As a method of removal of thrombotic material after a massive pulmonary embolism, flow reversal in the pulmonary circulation while on cardiopulmonary bypass has only been reported in case reports. 11 A recent study with retrograde perfusion in rat IPL demonstrated a sudden massive oedema formation after flow reversal in rat lung with pulmonary arterial hypertension induced by the vascular endothelial growth factor (VEGF) receptor protein tyrosine kinase 1/2 inhibitor Sugen 5416. 13 However, control lungs and lungs with hypoxic pulmonary hypertension showed no problems with retrograde perfusion and increasing flow rates for up to 60 minutes of perfusion and ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…Retrograde pulmonary perfusion in real‐life situations is rare. As a method of removal of thrombotic material after a massive pulmonary embolism, flow reversal in the pulmonary circulation while on cardiopulmonary bypass has only been reported in case reports . A recent study with retrograde perfusion in rat IPL demonstrated a sudden massive oedema formation after flow reversal in rat lung with pulmonary arterial hypertension induced by the vascular endothelial growth factor (VEGF) receptor protein tyrosine kinase 1/2 inhibitor Sugen 5416 .…”

Section: Discussionmentioning

confidence: 99%

“…In human patients, flow direction changes in the pulmonary circulation appear in high‐risk surgeries as retrograde perfusion (flow reversal). As ultima ratio therapy in serious cases of pulmonary embolism, an intraoperative flow reversal in the pulmonary vessels while on cardiopulmonary bypass sometimes is used to wash out remaining thrombotic material after thrombectomy . In experimental settings, retrograde pulmonary perfusion is used to reach pulmonary and bronchial vessels simultaneously for drug distribution, since pulmonary and bronchial arterial vessels arise separately, but drain into the same venous system .…”

Section: Introductionmentioning

confidence: 99%

“…As ultima ratio therapy in serious cases of pulmonary embolism, an intraoperative flow reversal in the pulmonary vessels while on cardiopulmonary bypass sometimes is used to wash out remaining thrombotic material after thrombectomy. 11 In experimental settings, retrograde pulmonary perfusion is used to reach pulmonary and bronchial vessels simultaneously for drug distribution, since pulmonary and bronchial arterial vessels arise separately, but drain into the same venous system. 12 To the best of our knowledge, only one study has reported successful retrograde perfusion in rat IPL 13 ; however, their experiments did not exceed 60 minutes.…”

Section: Introductionmentioning

confidence: 99%

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Retrograde perfusion in isolated perfused mouse lungs—Feasibility and effects on cytokine levels and pulmonary oedema formation

Krabbe

Ruske

Kanzler

et al. 2019

Basic Clin Pharma Tox

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Retrograde lung vascular perfusion can appear in high‐risk surgeries. The present report is the first to study long‐term retrograde perfusion of isolated perfused mouse lungs (IPLs) and to use the tyrosine kinase ephB4 and its ligand ephrinB2 as potential markers for acute lung injury. Mouse lungs were subjected to anterograde or retrograde perfusion with normal‐pressure ventilation (NV) or high‐pressure ventilation (=overventilation, OV) for 4 hours. Outcome parameters were cytokine, ephrinB2 and ephB4 levels in perfusate samples and bronchoalveolar lavage (BAL), and the wet‐to‐dry ratio. Anterograde perfusion was feasible for 4 hours, while lungs receiving retrograde perfusion presented considerable collapse rates. Retrograde perfusion resulted in an increased wet‐to‐dry ratio when combined with high‐pressure ventilation; other physiological parameters were not affected. Cytokine levels in BAL and perfusate, as well as levels of soluble ephB4 in BAL were increased in OV, while soluble ephrinB2 BAL levels were increased in retrograde perfusion. BAL levels of ephrinB2 and ephB4 were also determined in vivo, including mice ventilated for 7 hours with normal‐volume ventilation (NVV) or high‐volume ventilation (HVV) with increased levels of ephB4 in HVV BAL compared to NVV. Retrograde perfusion in IPL is limited as a routine method to investigate effects due to collapse for yet unclear reasons. If successful, retrograde perfusion has an influence on pulmonary oedema formation. In BAL, ephrinB2 seems to be up‐regulated by flow reversal, while ephB4 is a marker for acute lung injury.

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Value of retrograde pulmonary vein perfusion combined with pulmonary artery thrombectomy in acute pulmonary embolism: a protocol for a systematic review and meta-analysis

Xiang

Peng

et al. 2023

BMJ Open

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IntroductionAcute pulmonary embolism is a serious cardiovascular disease with high mortality. Surgery is an important therapeutic means. The traditional surgical method is pulmonary artery embolectomy with cardiopulmonary bypass, but there is a certain recurrence rate after surgery. Some scholars use retrograde pulmonary vein perfusion as an adjunct to conventional pulmonary artery embolectomy. However, whether this method can be used safely for acute pulmonary embolism and its long-term effects remains unclear. Therefore, we plan to conduct a systematic review and meta-analysis to investigate whether retrograde pulmonary vein perfusion combined with pulmonary artery thrombectomy can be safely used in acute pulmonary embolism.Methods and analysisWe will search key databases (Ovid MEDLINE, PubMed, Web of Science, Cochrane Library, China Science and Technology Journals and Wanfang) for studies on acute pulmonary embolism treated with retrograde pulmonary vein perfusion from January 2002 to December 2022. The useful information will be consolidated into a piloting spreadsheet. The Cochrane Risk of Bias Tool will be used to assess the bias. Data will be synthesised and heterogeneity will be evaluated. The dichotomous variables will be determined by using risk ratio with 95% CI, and weighted mean differences (with 95% CI) or standardised mean differences (95% CI) will be used for continuous variables. Χ2test and I2test will be used to assess the statistical heterogeneity. Meta-analysis will be conducted when strong homogeneous data are accessible.Ethics and disseminationApproval of the ethics committee is not needed for this review. While results will be disseminated electronically, effective dissemination will be done through presentations and peer-reviewed publication.PROSPERO registration numberCRD42022345812; pre-results.

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Retrograde lung perfusion in the treatment of massive pulmonary embolism. A randomised porcine study

Cited by 4 publications

References 11 publications

Never Change a Flowing System? The Effects of Retrograde Flow on Isolated Perfused Lungs and Vessels

Never Change a Flowing System? The Effects of Retrograde Flow on Isolated Perfused Lungs and Vessels

Retrograde perfusion in isolated perfused mouse lungs—Feasibility and effects on cytokine levels and pulmonary oedema formation

Value of retrograde pulmonary vein perfusion combined with pulmonary artery thrombectomy in acute pulmonary embolism: a protocol for a systematic review and meta-analysis

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