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Bilateral sequential lung transplantation: technical aspects

The surgical technique for lung transplantation has evolved dramatically over the last three decades. Significant improvements in short term outcomes in the early years of lung transplantation were due, in large part, to techniques developed to reduce airway anastomotic complications in single lung...

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Autores principales: Elgharably, Haytham, Javorski, Michael J., McCurry, Kenneth R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8662466/
https://www.ncbi.nlm.nih.gov/pubmed/34992835
http://dx.doi.org/10.21037/jtd-2021-22
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author Elgharably, Haytham
Javorski, Michael J.
McCurry, Kenneth R.
author_facet Elgharably, Haytham
Javorski, Michael J.
McCurry, Kenneth R.
author_sort Elgharably, Haytham
collection PubMed
description The surgical technique for lung transplantation has evolved dramatically over the last three decades. Significant improvements in short term outcomes in the early years of lung transplantation were due, in large part, to techniques developed to reduce airway anastomotic complications in single lung transplantation. Following development of the technique of en bloc double lung transplantation, evolution to the bilateral sequential technique further reduced airway complications for double lung transplantation. More recently, some programs have utilized the en bloc double lung transplant technique with bronchial artery revascularization to aid airway healing and potentially improve short- and long-term outcomes. The experience with bronchial artery revascularization remains limited to a few series, with the technique having not been widely adopted by most lung transplant programs. With the implementation of priority allocations schemes in many countries, patients with higher risk profiles are being prioritized for transplantation which results in more complex procedures in fragile recipients with multiple comorbidities. This includes the increased need for concomitant cardiac procedures as well as performing lung transplantation after prior cardiothoracic surgery. Different surgical approaches have been described for bilateral sequential lung transplantation with or without intra-operative mechanical circulatory support (MCS), such as sternotomy, clamshell (bilateral anterior thoracotomies with transverse sternotomy), and bilateral thoracotomy incisions. Herein, we aim, not only to describe the various surgical approaches for double lung transplantation, but to provide a comprehensive review of other aspects related to the recipient pathology and different anatomical variants as well as handling technical challenges that might be encountered during the procedure.
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spelling pubmed-86624662022-01-05 Bilateral sequential lung transplantation: technical aspects Elgharably, Haytham Javorski, Michael J. McCurry, Kenneth R. J Thorac Dis Review Article on Lung Transplantation: Past, Present, and Future The surgical technique for lung transplantation has evolved dramatically over the last three decades. Significant improvements in short term outcomes in the early years of lung transplantation were due, in large part, to techniques developed to reduce airway anastomotic complications in single lung transplantation. Following development of the technique of en bloc double lung transplantation, evolution to the bilateral sequential technique further reduced airway complications for double lung transplantation. More recently, some programs have utilized the en bloc double lung transplant technique with bronchial artery revascularization to aid airway healing and potentially improve short- and long-term outcomes. The experience with bronchial artery revascularization remains limited to a few series, with the technique having not been widely adopted by most lung transplant programs. With the implementation of priority allocations schemes in many countries, patients with higher risk profiles are being prioritized for transplantation which results in more complex procedures in fragile recipients with multiple comorbidities. This includes the increased need for concomitant cardiac procedures as well as performing lung transplantation after prior cardiothoracic surgery. Different surgical approaches have been described for bilateral sequential lung transplantation with or without intra-operative mechanical circulatory support (MCS), such as sternotomy, clamshell (bilateral anterior thoracotomies with transverse sternotomy), and bilateral thoracotomy incisions. Herein, we aim, not only to describe the various surgical approaches for double lung transplantation, but to provide a comprehensive review of other aspects related to the recipient pathology and different anatomical variants as well as handling technical challenges that might be encountered during the procedure. AME Publishing Company 2021-11 /pmc/articles/PMC8662466/ /pubmed/34992835 http://dx.doi.org/10.21037/jtd-2021-22 Text en 2021 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Review Article on Lung Transplantation: Past, Present, and Future
Elgharably, Haytham
Javorski, Michael J.
McCurry, Kenneth R.
Bilateral sequential lung transplantation: technical aspects
title Bilateral sequential lung transplantation: technical aspects
title_full Bilateral sequential lung transplantation: technical aspects
title_fullStr Bilateral sequential lung transplantation: technical aspects
title_full_unstemmed Bilateral sequential lung transplantation: technical aspects
title_short Bilateral sequential lung transplantation: technical aspects
title_sort bilateral sequential lung transplantation: technical aspects
topic Review Article on Lung Transplantation: Past, Present, and Future
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8662466/
https://www.ncbi.nlm.nih.gov/pubmed/34992835
http://dx.doi.org/10.21037/jtd-2021-22
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