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Bilateral sequential lung transplantation: technical aspects.

Haytham Elgharably1, Michael J Javorski1, Kenneth R McCurry1

  • 1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.

Journal of Thoracic Disease
|January 7, 2022
PubMed
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Lung transplant surgical techniques have advanced significantly, improving outcomes by reducing airway complications. Current methods address complex cases and diverse patient needs for better results.

Area of Science:

  • Cardiothoracic Surgery
  • Transplantation Medicine
  • Surgical Innovation

Background:

  • Lung transplantation has evolved over 30 years, with key advancements in surgical techniques improving short-term outcomes.
  • Early improvements focused on reducing airway anastomotic complications in single lung transplantation.
  • Subsequent evolution to bilateral sequential techniques further minimized airway issues in double lung transplantation.

Purpose of the Study:

  • To describe various surgical approaches for double lung transplantation.
  • To review recipient pathology, anatomical variants, and technical challenges in lung transplantation.
  • To provide a comprehensive overview of surgical advancements and their impact on outcomes.

Main Methods:

  • Review of historical surgical techniques for lung transplantation, including single and double lung procedures.
Keywords:
Lung transplantationbilateral sequentialsurgical technique

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  • Analysis of advancements such as en bloc and bilateral sequential double lung transplantation.
  • Discussion of newer techniques like bronchial artery revascularization and their limited adoption.
  • Examination of surgical approaches for complex cases, including concomitant cardiac procedures and prior cardiothoracic surgery.
  • Exploration of different surgical incisions (sternotomy, clamshell, bilateral thoracotomy) and use of mechanical circulatory support.

    • Main Results:

    • Surgical techniques have progressed from single to en bloc double and bilateral sequential lung transplantation, significantly reducing airway complications.
    • Bronchial artery revascularization is a newer technique with limited adoption but potential for improved airway healing.
    • Increasingly complex recipient profiles necessitate adaptations in surgical approaches, including combined procedures and transplantation after prior surgeries.
    • Various surgical approaches exist for bilateral sequential lung transplantation, each with specific indications and challenges.

    Conclusions:

    • Lung transplant surgical techniques continue to evolve, addressing airway complications and adapting to complex recipient profiles.
    • The choice of surgical approach for double lung transplantation depends on patient-specific factors and technical considerations.
    • Further research and wider adoption of innovative techniques may enhance outcomes in lung transplantation.