CYTOSTATIC LUNG PERFUSION BY USE OF AN ENDOVASCULAR BLOOD-FLOW OCCLUSION TECHNIQUE

Background. Different modalities of cytostatic lung perfusion were com pared regarding plasma and tissue drug concentrations to assess the ef ficacy of an endovascular blood now occlusion technique. Methods. A cy tostatic lung perfusion study with doxorubicin hydrochloride was perfo rmed on large white pigs (n = 12). Plasma and tissue concentrations of doxorubicin were compared for isolated lung perfusion with open cannu lation (ILP), blood now occlusion perfusion with open cannulation of t he pulmonary artery alone (BFO), and intravenous drug administration ( IV). In a fourth group, thoracotomy-free BFO perfusion was performed b y endovascular balloon catheterization of the pulmonary artery (endova scular BFO). The 3 animals in this group were used to compare the doxo rubicin-perfused pulmonary tissue with the contralateral nonperfused l obes after 1 month. Results. The mean lung tissue doxorubicin concentr ation at the end of perfusion was 19.8 +/- 1.6 mu g/g after ILP, 27.6 +/- 2.2 mu g/g after BFO (p = not significant), and 3.0 +/- 0.8 mu g/g after IV perfusion (p < 0.01). Whereas doxorubicin was not detectable in the plasma in the ILP group, concentrations ranged from not detect able to 0.44 mu g/mL in the BFO group and from 0.31 to 0.84 mu g/mL in the IV group (p < 0.05). Mean myocardial tissue concentration was not significantly different after BFO than TV perfusion (1.1 +/- 0.5 mu g /g and 1.8 +/- 0.1 mu g/g, respectively). In the endovascular BFO grou p, balloon-blocked pulmonary artery perfusion was successfully perform ed in all animals, and after 1 month, lung tissue showed no cytostatic -induced histologic changes. Conclusions. Compared with ILP, BFO cytos tatic lung perfusion produced an insignificantly higher lung-tissue co ncentration, corresponding to a sixfold to ninefold higher level than after IV perfusion. Plasma drug levels during BFO perfusion were lower than during IV perfusion. Endovascular BFO may be a promising techniq ue for repeated cytostatic lung perfusion. (C) 1998 by The Society of Thoracic Surgeons.