No-clamp technique for pulmonary artery and venous anastomoses in lung transplantation

Lung transplantation (LTx) is a complex surgical procedure conventionally performed with clamps on the recipient pulmonary artery (PA) and left atrial (LA) cuff, with or without cardiopulmonary bypass (CPB). The clamps may be awkward to apply and maintain on these structures, potentially causing injury and possibly compromising the quality of anastomosis. We describe a no-clamp technique for performing these types of anastomoses.

A total of 184 LTx procedures performed under CPB were grouped depending on clamping of recipient PA and LA during anastomosis using either the "no-clamp" technique (Group 1, n = 41) or the conventional technique (Group 2, n = 143). Pre-operative donor and recipient demographics and baseline characteristics as well as post-operative outcomes were compared.

The demographics and pre-operative baseline characteristics of donors and recipients in both the groups were similar. Patients in Group 1 had a significantly shorter total ischemic time (p < 0.001), CPB time (p < 0.001), decreased incidence of post-LTx atrial fibrillation (p = 0.048), less need for blood and blood products transfusion, and fewer post-LTx pulmonary infections (p = 0.038). No patient in any group had post-LTx stroke. Although the incidence of post-operative bronchiolitis obliterans syndrome (BOS) did not differ between the two groups (p = 0.638), patients in Group 1 had significantly better mid- and long-term survival (p = 0.013): 89.7% vs 80%, 89.7% vs 66.5% and 89.7% vs 62.2% at 1, 3 and 6 years after LTx, respectively.

The no-clamp technique for anastomosis of PA and LA in LTx is feasible and safe. It may reduce warm ischemia time as well as CPB time, with improvement in post-LTx outcomes. It may also reduce the incidence of post-LTx atrial arrhythmias.