Bronchial artery revascularization in lung transplantation: revival of an abandoned operation

Current results of lung transplantation still lag behind those of other solid-organ transplants. Although bronchial dehiscence was the main cause of early mortality in the past, modern-day operative techniques and immunosuppression regiments have decreased, but not eliminated, this complication. Current barriers to long-term survival are chronic lung allograft dysfunction and infection. Bronchial artery revascularization was effective in decreasing bronchial anastomotic complications, but it was largely abandoned because of technical challenges.

Long-term follow-up in patients with bronchial artery revascularization has shown a survival advantage compared with the standard lung transplant technique. Recent data also show decreased infection, decreased early rejection and decreased bronchiolitis obliterans syndrome, in addition to confirming the known advantages in bronchial healing. Modifications of the technique have also made bronchial artery revascularization feasible in the pediatric population.

Bronchial artery revascularization, although initially designed for bronchial healing, has clinical advantages that extend long term, including survival, infection and decreased graft dysfunction. Its usage in lung transplantation needs to be revisited.