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Bilateral sequential lung transplantation without sternal division.

Federico Venuta1, Erino A Rendina, Tiziano De Giacomo

  • 1Cattedra di Chirurgia Toracica, 'La Sapienza', University of Rome, Policlinico Umberto I, V.le del Policlinico, 00161, Rome, Italy. sofed@libero.it

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|June 28, 2003
PubMed
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Bilateral sequential lung transplantation using anterolateral thoracotomy without sternal division reduces complications and improves early respiratory function compared to the standard clamshell incision.

Area of Science:

  • Thoracic Surgery
  • Transplantation Medicine
  • Surgical Innovation

Background:

  • The clamshell incision is standard for bilateral sequential lung transplantation (BSLT) but associated with significant morbidity.
  • Chest wall complications are a concern with the traditional clamshell approach.

Purpose of the Study:

  • To evaluate the safety and efficacy of bilateral anterolateral thoracotomy without sternal division as an alternative to the clamshell incision for BSLT.
  • To compare outcomes, including complications and respiratory function, between the two surgical approaches.

Main Methods:

  • A prospective series of 34 patients underwent BSLT using bilateral anterolateral thoracotomy (Group I).
  • Results were retrospectively compared to a historical control group of 37 patients who had BSLT via clamshell incision (Group II).

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Main Results:

  • Group I demonstrated shorter operative times (228 vs. 293 min) and reduced intensive care unit (5 vs. 13 days) and hospital stays (25 vs. 32 days).
  • Significantly higher vital capacity (65% vs. 45%) and FEV1 (71% vs. 58%) were observed in Group I at 3 weeks post-transplant.
  • No wound complications occurred in Group I, whereas Group II experienced 17 chest wall complications, including sternal osteomyelitis and prolonged pain.

Conclusions:

  • Bilateral anterolateral thoracotomy without sternal splitting is a safe and effective approach for BSLT.
  • This technique effectively avoids sternal complications and enhances early postoperative respiratory function.