Anterolateral vs. Clamshell Thoracotomy for Bilateral Lung Transplantation.

Area of Science:

• Thoracic Surgery
• Transplantation Medicine
• Surgical Innovation

Background:

• Clamshell thoracotomy is the standard for bilateral sequential lung transplantation (LuTx), but associated with significant morbidity.
• Anterolateral thoracotomy presents a less invasive surgical alternative without sternal division.
• Evaluating the optimal surgical approach for LuTx is crucial due to the technical challenges of anterolateral thoracotomy.

Purpose of the Study:

• To compare the outcomes of bilateral sequential lung transplantation (LuTx) using anterolateral thoracotomy versus clamshell thoracotomy.
• To identify the more favorable surgical approach in terms of patient outcomes and complications.

Main Methods:

• Retrospective cohort study of adult patients undergoing LuTx between 2010 and 2022.
• Multivariable regression analyses were used to assess the impact of surgical approach on mortality, operative outcomes, and complications.
• Comparison between anterolateral thoracotomy (n=132) and clamshell (n=117) groups.

Main Results:

• Anterolateral thoracotomy group had longer operating/ischemic times but less intraoperative extracorporeal circulation (ECC) use, blood loss, and transfusions.
• Similar survival rates were observed between groups.
• Shorter ICU/hospital stays, reduced mechanical ventilation duration, and significantly fewer wound-related complications in the anterolateral thoracotomy group.
• Lower intraoperative ECC use in anterolateral thoracotomy correlated with better outcomes.

Conclusions:

• Anterolateral thoracotomy is a favorable alternative to clamshell incision for LuTx.
• Despite technical challenges, anterolateral thoracotomy leads to comparable survival with reduced peri- and post-operative complications.
• Faster patient recovery is associated with the less invasive anterolateral thoracotomy approach.