Bronchial artery revascularization in lung transplantation: techniques, experience, and outcomes

Lung transplantation (LTX) is routinely performed ignoring the bronchial arteries. In this article, we review the published world experience, including our own, of LTX with direct bronchial artery revascularization (BAR) and describe the anatomy of the bronchial arteries and our surgical technique.

The published experience of LTX with BAR consists of only a few small single-institution series, all with good success rates and outcomes. The bronchial artery anatomy will allow identification of useful arteries for BAR in most donors and double LTX (DLTX) with BAR is almost always possible. For single LTX (SLTX), BAR is feasible in about 50%. The surgical techniques for DLTX and SLTX with BAR has been well described. Our own combined Copenhagen and Cleveland experience, all BAR procedures performed or supervised by G.B.P., include a total of 131 LTX with BAR. BAR was performed with a success rate of over 90%, DLTX 95%. Success was uniformly associated with normal airway healing and the overall Copenhagen 5 and 10-year survival for DLTX with BAR was superior to that reported by other institutions after sequential bilateral lung transplantation.

LTX with BAR is feasible, successful and well tolerated. Success ensures normal airway healing. The Copenhagen experience suggests possible long-term survival benefit inviting to a multicenter study to define the role of BAR in LTX.