ABSTRACT
When the abdominal dissection is complete, including placement of perfusion cannulas, a cardioplegia cannula is placed and secured in either the midportion of the ascending aorta or the innominate arterial trunk. If lung procurement is planned, the midportion of the main pulmonary artery is also cannulated at a site that depends on the type of lung transplant procedure that is planned. When all organ procurement teams are ready, the SVC is ligated proximally and divided. To prevent infusion of liver preservation solution into the heart, a clamp is placed across the IVC at the level of the diaphragm and divided between the clamp and right atrium (Fig. 83-2). This prevents the preservation solution from venting into the pericardium and allows for the exposure required for the remaining dissection in order to preserve appropriate vascular cuffs, especially when simultaneous lung bloc procurement is to be attempted.[2] A large-bore catheter placed in
the infrarenal IVC allows for a controlled drainage of the cava while preventing flooding of the abdominal operative field from a divided IVC. The aortic crossclamp is placed with the initiation of both cardioplegia infusion and pulmonary preservation infusion. To vent the left heart as the perfusate returns through the pulmonary veins, the tip of the left atrial appendage is excised.[1] The heart and lungs are then bathed in ice cold saline solution while the preservation solution infusions are completed.
