Bilateral bronchial anastomosis in double lung and heart-lung transplantations

Abstract

During heart-lung or double lung transplantation, the airway anastomosis is usually made at the tracheal level. Healing of this anastomosis is one source of postoperative complications especially after double lung transplantation (DLT). In this series of 10 patients with cystic fibrosis undergoing DLT, the tracheas of donor and recipient were anastomosed with omental wrapping in 2 cases while the two main stem bronchi were joined without omental wrapping in 8. Endoscopy disclosed no sign of ischaemia in the patients with bilateral bronchial anastomoses. Three patients died on day 20, 21 and 35, respectively, after DLT. Two of these patients (one with a tracheal and the other with bronchial anastomoses) showed no complication at the level of the suture line. The third patient (with bronchial suture) suffered dehiscence of both anastomoses which was attributed to a misdosage of corticosteroids. Of the 6 patients alive after bronchial anastomosis, 3 recovered uneventfully and 3 who had required prolonged postoperative mechanical ventilation developed bronchomalacia. Bronchomalacia was treated by laser resection and stenting. Dehiscence did not occur in any of these six cases. This technique was based on the findings of 12 fresh cadaver dissections showing that collaterals between the bronchial arteries and the pulmonary arteries and veins extend up to the origin of the main stem bronchus. Bronchial suture without omental wrap may be used for double lung and heart-lung transplantation instead of tracheal suture.

Clinical Experience With a New Removable Tracheobronchial Stent in the Management of Airway Complications After Lung Transplantation

“…7 The bronchial artery circulation is generally not reestablished during transplantation, and blood is supplied by the pulmonary artery with collaterals with the bronchial arteries in a retrograde manner. 39,40 Necrosis at the suture line frequently leads to airway dehiscence. 31 Other factors thought to be responsible for defective airway healing are prolonged postoperative mechanical ventilation, anastomotic technique, recurrent infections, and acute rejection.…”

Bronchial anastomotic complications following lung transplantation: still a major cause of morbidity?

“…In the period from 1986 to 1989, following en bloc double-lung transplantation 25% of the patients died due to ischaemic complications of the tracheal anastomosis [1]. Sequential single-lung transplantation with bilateral bronchial anastomosis and further technical improvements, as well as better preservation and postoperative management, reduced the incidence of ischaemic airway complications [2]. Bronchial complications with a mortality of 2-4% are still reported in 4-12% of lung transplant recipients [3,4].…”

Gastric Bezoar After Lung Transplantation in Non–Cystic Fibrosis Patients and Review of the Literature

“…18 Au et al described the upper GI dysmotility associated with compromise of branches of the vagus nerve during heart-lung transplantation. 20 This complication is usually related to the surgical manipulation of the posterior mediastinum during the tracheal anastomosis, which has been substituted for a sequential right and left single-lung transplant 21,22 with bronchial anastomosis. This technique also generally avoids the need for cardiopulmonary bypass.…”