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Improved technique for bilateral lung transplantation: rationale and initial clinical experience
M K Pasque1, J D Cooper, L R Kaiser
1Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri.
The Annals of Thoracic Surgery
|May 1, 1990
Summary
A new, simpler lung transplant technique offers improved outcomes by reducing airway ischemia and preserving cardiac function. This sequential bilateral lung replacement method is easier to master and widely applicable.
Area of Science:
- Thoracic Surgery
- Transplantation Medicine
- Cardiopulmonary Surgery
Background:
- En bloc double-lung transplantation is complex with limitations like airway ischemia and cardiac issues.
- Previous techniques for bilateral lung replacement presented significant surgical challenges and complications.
Purpose of the Study:
- To develop and evaluate a simpler, safer technique for sequential bilateral lung transplantation.
- To overcome the limitations of en bloc transplantation, including airway ischemia and cardiac complications.
Main Methods:
- A novel surgical approach using transverse thoracosternotomy for sequential lung replacement.
- Separate bronchial anastomoses to minimize airway ischemic time.
- Avoiding total cardiopulmonary bypass and cardiac ischemic arrest.
Main Results:
- Successful application in 3 patients with emphysema, cystic fibrosis, and bronchiolitis obliterans.
- Excellent postoperative function despite lung ischemic times up to 9.5 hours.
- Reduced incidence of airway ischemia, myocardial depression, and cardiac denervation.
Conclusions:
- The sequential bilateral lung transplantation technique is simpler, safer, and more widely applicable.
- This method effectively reduces complications associated with en bloc transplantation.
- The technique demonstrates excellent clinical outcomes and functional recovery.